Earlier this month, AcademyHealth and partners Allergy & Asthma Network, Asthma and Allergy Foundation of America, GlaxoSmithKline, and Research!America hosted the third in a series of congressional briefings on the “research continuum” and how different types of research—basic, clinical, health services, and population—complement one another in preventing and treating diseases and conditions. The first briefing was on heart disease, the second, on cancer, and the third focused on asthma and allergies.
According to the Centers for Disease Control and Prevention (CDC), an estimated 24 million Americans (one in 12) are living with asthma; it costs $56 billion annually. Of those with severe asthma, two-thirds are unable to work full time. Allergies, which can trigger asthma symptoms, are among the most common chronic diseases, affecting more than 50 million people and costing in excess of $18 billion each year.
To kick things off, mother and patient Vernetta Santos spoke to attendees, reminding everyone of the need for and impact of research: the patients. Ms. Santos has been “dealing with asthma for 23 years.” Not only does she struggle with asthma, but her three children are affected as well. As she says, “It’s a scary ride from the beginning.”
Dr. Kirk Druey, National Institute of Allergy and Infectious Diseases (NIAID), then discussed the role of basic science, which increases knowledge about how living organisms work and what causes disease. Dr. Druey explained that, because of basic research trials, researchers have determined that asthma may have multiple causes and may represent at least two—and probably more—distinctive diseases. Precision medicine has enhanced this work by allowing researchers to take a virtual snapshot of the human genome and work with partners to match the unique patient to an individual, effective therapy.
Following Dr. Druey’s presentation, Dr. Catherine Bonuccelli of GlaxoSmithKline (GSK) noted that it’s an unprecedented time for medicine and science. She spoke of the exciting developments in precision medicine, such as the development of a new therapy that provides a segment of severe asthma patients with a treatment customized to their specific condition. Unfortunately, she said, developing those medicines isn't easy. The average time to develop a new medicine is clinically between 10 and 15 years. Dr. Bonuccelli noted the important role of patient partnerships moving forward, since for patients it's not just about having a disease—it's the different experience the disease brings to each patient and his/her family, friends, and community.
Also speaking to the importance of the patient relationship was Dr. Michael Cabana, who presented on the role of health services research (HSR) to ensure that evidence is implemented in the right way at the right time. As we’re all too aware, patient visit time is often limited; during that encounter, physicians have to establish rapport, address the patient’s symptoms, complete a history and physical exam, and establish a plan, ideally one suited to patients’ different beliefs, concerns, and goals about their specific treatment. One way to improve those encounters, he explained, is through HSR-informed programs like the Physician Asthma Care Education (PACE) program—an educational seminar to improve physician awareness, ability, and use of communication and therapeutic techniques for reducing the effects of asthma on children and their families. Data has shown that this program has resulted in improved health care provider confidence; providers being more likely to use better communication and education techniques; decreased asthma symptoms reported by families; and decreased emergency department visits for asthma patients. Dr. Cabana described it as a critical kind of personalization beyond science.
The fourth and final type of research presented, population-based research, touches people where they live, learn, work, play, and pray. As Dr. Simpson reminded attendees at the beginning of the briefing, “Your zip code is often more important than your genetic code” in predicting health. Speaking on this perspective was Dr. Tyra Bryant-Stephens from The Children’s Hospital of Philadelphia. Dr. Bryant-Stephens began her research driven by the question of why children receiving care consistent with national guidelines were still ending up in the ER. She learned that biology is only part of the answer — as laid out in the CDC's Determinants of Health, health outcomes are determined by lifestyle (50 percent), environment (20 percent), biology (20 percent), and the health system (10 percent).
Dr. Bryant-Stephens turned that knowledge into action, working with her team in the Community Asthma Prevention Program, which utilizes community health workers and residents to implement asthma interventions in underserved, poorly-resourced inner-city communities. Their program resulted in reduced hospitalizations, emergency room visits, sick visits, and asthma symptoms.
Pulling It All Together
Ultimately, these briefings continue to show that despite there being many different types of research, each plays an integral function in the larger health enterprise. Any one type of research on its own cannot effectively or appreciably improve health and health care. It takes basic research to teach us the fundamentals of disease, clinical research to make advancements in (targeted) medications and therapies, health services research to move what works to the right group of patients in the right setting and at the right time, and population research to work with communities to ensure that we're taking the right steps to prevent, educate, and treat patients in the places where they live their lives.