2016 National Academy of Medicine President’s Address

Below is Victor J. Dzau’s President’s Address, delivered at the National Academy of Medicine Annual Meeting on October 17, 2016.

Good morning, and welcome to our members, guests, and friends — those of you here in the room and those joining via the live webcast. It is an honor to be addressing you today as your president. I would like to take a moment to acknowledge the past presidents of the National Academy of Medicine who are present: Harvey Fineberg, David Hamburg, Stuart Bondurant, and Sam Thier. Thank you all for your past leadership and current support.

At last year’s annual meeting, we celebrated the launch of the National Academy of Medicine (NAM) and the 45th anniversary of the Institute of Medicine, the foundation on which our new Academy is built. Together, we have achieved much in our first year as the NAM, but there is still much to do.

Responding to Urgent Challenges

John F. Kennedy once said, “Time and the world do not stand still. Change is the law of life.” Those words ring so true, especially today. In about three weeks, our country will elect a new president and a new Congress. Whoever is elected, she or he will be grappling with the same challenges in health and medicine with which we are all-too-familiar. They are:

• How do we accelerate progress toward a U.S. health care system that will deliver better health and higher value and that is more equitable for everybody?
• How can we ensure that science is valued and has the robust funding needed to thrive?
• How do we respond rapidly to new threats such as Ebola or Zika — threats that are not only national but international in scope?
• How do we as a nation, irrespective of our race, gender, education and political alliance, work together to improve health for all?

As the premier advisor to the nation on health, the NAM stands ready to provide guidance to the next U.S. administration on these challenges. That’s why we have launched a bold initiative called Vital Directions for Health and Health Care — an initiative to which many of you have contributed. The initiative focuses on identifying policies and actions that could yield timely, measurable progress toward three key goals for the United States: better health and well-being, high-value health care, and strong science and technology.

To begin, we convened a distinguished steering committee made up of the nation’s leading health care and policy experts to guide the initiative, and they in turn identified 19 priority focus areas within the three overarching goals. We commissioned expert papers on each of these topics from nearly 150 of the nation’s leading researchers, scientists, and policy makers. The views in these papers are those of the expert authors and do not represent formal consensus positions of the NAM. The NAM’s role was to to conceptualize, convene, commission, and communicate. The result is a rich, deep resource covering a breadth of the most crucial challenges in health today — from a systems approach to the life course to social determinants of health and specific conditions such as mental health and aging; from payment reform and accountable care to workforce development; and, importantly, from strong science and technology to IT interoperability to the importance of data to training for 21st century science.

The 19 papers were published as NAM Perspectives on September 19, and a companion series of JAMA Viewpoints was published a week later. On the same day, we held a major symposium called “A National Conversation.” The meeting helped stimulate input from a broad range of voices, with more than 500 people participating either in person or via webcast. We held this event because we want to learn directly from stakeholders about the issues they believe are most important, and, at the President’s Forum later today, we will talk with Tom Daschle, Risa Lavizzo-Mourey, Mike Leavitt, Mark McClellan, and Larry Tabak about Vital Directions. We want your active input — please share your thoughts with us.

The next step is for the steering committee to write a synthesis paper, informed by these conversations, that crystallizes all of the information we have gathered into actionable directions. With your input, the priorities identified will inform the incoming administration, Congress and health leaders across the country about how they can and should make real, measurable improvements in health throughout 2017 and beyond.

A National Academy with Global Scope

As the foremost academy in health and medicine, we stand ready to work with our friends and partners internationally to address Global Health challenges. With the recent Ebola and Zika outbreaks, we have worked tirelessly to convene the best minds to address the problem of emerging infectious diseases through many workshops and roundtables; and, importantly, last year we commissioned the report on a Global Health Risk Framework of the Future, a blueprint for countering international infectious disease crises.

The initiative was launched in response to the Ebola crisis in West Africa, in which more than 11,000 people lost their lives. That tragedy was a major wake-up call for the global health community, which was woefully unprepared to handle the outbreak. At the urging of NAM member Dr. Jim Kim, president of the World Bank, and with encouragement from Dr. Margaret Chan, director-general of the World Health Organization (WHO) — and with the generous support of seven foundations — our Academy quickly convened an independent, international commission of experts in finance, governance, R&D, health systems, business and the civil society. Several NAM members served as commissioners: Paul Farmer, Maria Frayer, Julio Frenk, Larry Gostin, Francis Omaswa, and Tachi Yamada.

The Commission recommended a three-pronged framework to counter infectious disease crises: (1) strengthening global and regional coordination and capabilities to respond to epidemics with a re-energized WHO; (2) building public health and resilient health systems globally; and (3) accelerating R&D to counter the threat of infectious diseases. The report took a unique approach to framing the issue — spotlighting pandemics as a major global economic and security risk. It’s sad but true that, sometimes, when we frame issues purely as a matter of health or health care, it can be hard to capture the attention of government leaders. So, in this report, we led with the message that, in addition to killing tens of millions, pandemics could cost in excess of $6 trillion in the 21st century, or an expected loss of more than $60 billion per year. Thus we described pandemics as a neglected dimension of global security.

The report argued that, compared to what we stand to lose, investing $4.5 billion per year in preparedness and response — or just 65 cents per person — is a very small price to pay. Indeed, it is a small fraction of what the global community spends on other high-profile threats to human and economic security — such as war, terrorism, nuclear disasters, and financial crises. Although some may still see this as a steep investment, it will pay dividends by protecting human lives and livelihoods and safeguarding the global economy against the incredible damage pandemics can cause. As the Ebola epidemic showed us, we are underinvested and underprepared.

I am glad that this report has and continues to help shine a global spotlight on these issues. We launched the report in New York and Hong Kong earlier this year, and we are planning a launch in Africa in conjunction with the African Union. This and other related reports were widely discussed at the World Economic Forum in Davos and at the WHO Executive Board, the World Health Assembly, and the World Bank annual meeting. It also informed the G7 world leader’s summit in developing its position on pandemic preparedness, and has been cited in numerous articles and op-eds. I am very proud of the impact that this initiative has had, and I extend my sincere thanks to all of you who lent your expertise to this project. I also want to thank Dr. Margaret Chan for her support and receptivity to our recommendations. We are grateful to her leadership and for the actions she has taken to prepare the world for future outbreaks.

Recognizing NAM Members

As you can you see, in our first year as a full-fledged Academy we are already making an impact in the U.S. and globally. One thing that both of these efforts have in common is their reliance on the expertise and insight of NAM members and other experts who volunteer their time and talent to help us make a difference. This is why it is so important to be an Academy of the highest standing and excellence. Becoming an Academy was an achievement decades in the making. It reflects the great professional distinction of our members and their significant contributions to health, science, and policy. Today, I would like to take time to recognize and celebrate our members.

NAM members are elected by their peers in recognition of outstanding achievement. Today, our national and international membership represents more than 2,000 of the world’s leaders in health, health policy, and biomedical science. Our members have made breakthrough discoveries, cured diseases, tackled global pandemics, developed novel therapies and innovative care delivery models, and led the way in proposing and implementing policy changes that have advanced health for us all. You truly represent the best and the brightest. You are at the cutting edge of major scientific breakthroughs. You are the architects of significant field advances both here in the U.S. and abroad. You are exceptional health care practitioners, researchers, and academics. And through your commitment to volunteer service, you help guide the work and advance the mission of the NAM — and also of the rest of the National Academies.

To highlight some of the recent achievements by our members, just last year, Paul Modrich won the 2015 Nobel Prize in Chemistry for his pioneering work on DNA repair. And this year’s new-member inductees include May-Brit Moser and Edvard Moser, winners of the 2014 Nobel Prize in Physiology or Medicine; Shinya Yamanaka, winner of the 2012 Nobel Prize in Physiology or Medicine; and Mario Capecchi, winner of the 2007 Nobel Prize in Physiology or Medicine. We are thrilled to welcome them aboard and I’m sure we’re all looking forward to working closely with them in the future.

Just last month, William Kaelin and Gregg Semenza received the Lasker Award for basic medical research. This past year, Albert Bandura, Stanley Falkow, Rakesh Jain, and Mary-Claire King received the the National Medal of Science past year. Most recently, Cato Laurencin, Mark Humayun, and Joseph DeSimone received the National Medal of Technology and Innovation. But the accomplishments of our members are not limited to innovation in science and technology. We have global humanitarians among our ranks. Denis Mukwege, from the Democratic Republic of Congo, was elected in 2014 and, that same year, he was awarded the European Union’s prestigious Sakharov Prize for his long-term commitment to protecting the victims of gang rape and sexual violence. Also within our membership, we are also fortunate to have great scholars and educators. For example, Abraham Verghese was a 2015 National Humanities Medalist.

These awards and prizes are wonderful, but they don’t come close to fully conveying the incredible breadth of our members’ contributions. I can say without a doubt that the field — and the state of health in our nation and the world — wouldn’t be where it is today without our members’ courage, vision, and leadership.

And we are incredibly fortunate at the National Academies to be able to draw upon your diverse range of expertise and experiences. What’s more, your level of engagement with the NAM and the National Academies is remarkable. I am proud to report that nearly 20 percent of NAM members participated on National Academies committees last year, the highest participation rate of all three Academies’ memberships. The vast majority of that participation was on activities taking place in NAM and the Health and Medicine Division (HMD). In 2015, 84 members served in a leadership role, 362 were committee members, and 154 contributed to the report review process. In fact, from 2005 to 2015, more than 1,100 of our members volunteered in some capacity on behalf of the National Academies. That is an impressive number!

Indeed, many current studies and activities under way in HMD are being led by NAM members — overseeing consensus studies, chairing board committees, leading forums and roundtables, and moderating workshops. I am so grateful to all of you who have and continue to volunteer your time for the Academies. I know I can count on you, and that means a lot to me. I can’t emphasize it enough – our members are the NAM.

Member engagement is essential to the NAM’s work, and I am always looking for new, meaningful ways to involve members:

• I have generated an informal monthly newsletter to keep members abreast of recent developments, and with an open invitation for feedback and suggestions. This has been very well received.
• The NAM has undertaken a strategic planning effort to guide the next phase of the Academy, which I will discuss in greater detail. When I asked for volunteers to serve on the planning group to ensure balanced representation of ideas and disciplines, more than 60 of you stepped up.
• We have launched the first annual Business Meeting in which NAM officers report to membership about our progress and activities, review our finances, and engage in a direct and open conversation with members.
• To increase engagement with the scientific and health communities, we have decided to hold the NAM’s Rosenthal Symposium annually outside Washington, starting this December in Seattle.
• Going forward, I hope to engage even more NAM members through our interest groups.

National Academies Reorganization

At this point, I would like to give you a report and my assessment of the reorganization of the National Academies, which took up a large portion of my time and energy this past year. First, becoming a full Academy affords us even greater opportunities to act as the field leader for health and medicine. With the reorganization of the National Academies under the umbrella of the National Academies of Sciences, Engineering, and Medicine, we have taken a major step forward to integrate, collaborate, and take a cross-disciplinary approach to our work.

In partnership with the NAS and NAE, the NAM can now more easily draw on expertise across disciplines and domains to advance science, policy, and practice in research, health, medicine, and their many intersecting fields. Together, we have a once-in-a lifetime opportunity to continue to define our Academy and chart its course for the future. The key to success for the National Academies is our reputation for integrity, trustworthiness, independence, and credibility.

The NAM’s goal is to be the nation’s most trusted source for sound advice on science, policy, and practice related to health. We are committed to applying scientific rigor and objective evidence to achieve balanced, authoritative solutions to complex challenges. We generate momentum around critical issues; marshal diverse expertise to build evidence-based solutions; inspire action through collaboration and public engagement; and help develop the next generation of leaders and innovators.

We have long believed that health impacts should be considered in all policy decisions. Now, with the reorganization, we are better positioned to lend health and medical expertise across the National Academies, collaborating with fields such as the social sciences and education, earth and life sciences, physical and engineering sciences and transportation.

The three Academies now equally oversee all of the work of the National Research Council (NRC) and its divisions. For a long time, both internally and externally, we saw health and medicine programs as belonging solely to the IOM, under the governance of the IOM Council. And the old IOM had less of a role in the work of other NRC program divisions. With this new integrated structure, we are better positioned to respond to a rapidly evolving and interconnected world.

Thus, going forward, the NAM supports and promotes all work related to health and medicine at the National Academies, whether it comes from the Health and Medicine Division, or the Division of Behavioral and Social Sciences and Education, or the Division on Policy and Global Affairs, or any of the other program units. Now, more than ever before, all of us are working across divisions and Academies toward common goals.

Indeed, since the reorganization, there are many more examples of NAM members serving on NRC division committees, non-HMD boards, forums and roundtables, and the Report Review Committee; members such as Nancy Adler, Alto Charo, Bill Stead, Ellen Clayton, Angela Diaz, and Keith Yamamoto to name a few. Of note, Steve Hyman, Lynn Goldman, and Tachi Yamada are now serving on the NRC governing board. So, as a full Academy, we have already taken a major step forward in terms of integration, collaboration, and cross-disciplinary work.

The NAS and the NAE each have longstanding defined roles and responsibilities with the NRC and its divisions, including oversight, reporting, accountability, and financing. Indeed, these roles and relationships can serve as a guide for NAM and the NRC divisions. The timing of this opportunity could not be better. As I mentioned before, I believe that forging convergence across disciplines is how we will move the needle in today’s complex landscape.

In keeping with this spirit, while the individual activities of the three Academies are branded as those of the respective Academy, all of our consensus reports from the program units are now branded as reports of the National Academies of Sciences, Engineering, and Medicine. We believe this cohesive branding better communicates the cross-disciplinary approach that we apply to all issues.

Of course, change always brings challenges and confusion, and we are working hard to explain the reorganization and mitigate the anxiety and confusion among our staff, members and stakeholders.

Now that we are a new Academy, I have recruited and developed a new senior leadership team — including a new executive officer, Mike McGinnis, new chief of staff, and directors of development, finance and administration, membership, and communications. I am pleased to report to you that the work is completed, and I am confident we have an outstanding team which will lead this Academy into the future. I am also pleased to inform you that the operations and finances are now in very good shape.

In the midst of all of these changes, it is important for us to remember one thing that will never change: the pride we have in our IOM roots. The staff from IOM, most of who now work in HMD, share our mission, our history, and our kinship. We are firmly committed to building and extending the synergy of those ties in all we do together with HMD, and across all the Divisions.

NAM Programs and Initiatives

At this point, I would like to review the programs and initiatives of NAM with an eye to the future. At the beginning of my remarks, I told you about a couple of NAM’s initiatives; now I would like to tell you about the NAM’s standing programs.

First, our Leadership Consortium for a Value and Science-Driven Health System, led by Mike McGinnis, is working toward a continuously learning health system. Through the consortium, national leaders, organizations, and agencies are working collaboratively on efforts ranging from digital interoperability and advancing a new paradigm of real-time evidence generation, to accelerating progress on value-based care and the full engagement of patients and families in care decisions.

Second is the Innovation to Incubation program, led by Kimber Bogard, which champions innovative ideas and cultivates pathways to action so as to increase the NAM’s impact on the future of health and health care. Right now, Kimber is working with numerous states to develop implementation plans based on recommendations in the report “Transforming the Workforce for Children Birth to Age 8: A Unifying Foundation”.

And third, we have the Health Policy Educational Programs and Fellowships, led by Marie Michnich, which is designed to foster the next generation of leaders in health and health care.

In addition to these standing programs, we have launched a number of new initiatives. The NAM’s Culture of Health Program is well under way. The program is a collaborative, National Academies-wide effort led by NAM to identify types of successful and sustainable practices, policies, and partnerships. The ultimate goal is to scale effective efforts and promote health equity so that every person can achieve good health and well-being. In just a few months, the first consensus study associated with this program, which is focused on community-based solutions to promote health equity in the U.S., will be completed and released.

We are grateful to the Robert Wood Johnson Foundation, which has provided a grant and an endowment to support this five year-program. At this time, I’d like to personally acknowledge and thank NAM Member Risa Lavizzo-Mourey, President of RWJF, who is stepping down after 14 years of trail-blazing work there. Risa has been a tireless advocate for health equity for all Americans, and under her tenure, the foundation has taken on many bold and transformative initiatives on childhood obesity and building a culture of health, among many others. Thank you, Risa.

Another area I know many of us are well aware of is the growing burden of stress and burnout among clinicians. My clinical friends and colleagues are faced with so many demands and stresses these days, and many are overwhelmed with workload and responsibilities. Some alarming trends are emerging. Recent research indicates that physicians have twice the risk of burnout as the general population, and the rate of serious problems such as depression or suicidal ideation among physicians is also alarmingly high — around 39 percent. And it’s not just physicians who are experiencing high rates of burnout — nurses and other health professionals struggle as well. This could have terrible consequences, not only for the clinicians themselves, but also for the profession, and importantly, for patient care.

In July, at the urging of the AAMC and the ACGME, the NAM convened a meeting to discuss these challenges and explore future actions. In a testament to the intensity of interest, 30 national associations, as well as federal agencies and other stakeholders, actively participated in this exploratory meeting. As follow-up, I am pleased to announce that the NAM will lead a collaborative platform on clinician well-being and resilience that will catalyze stakeholder engagement and perform root cause analysis, all of which may lead to a consensus report to recommend changes in work-life environment and national policies to reduce clinician stress and burnout. Again, we welcome the participation of all of you in this effort — please don’t hesitate to reach out if you would like to be involved.

The NAM is also launching an initiative on Grand Challenges in Health and Medicine, led by a working group chaired by Bob Horvitz. The initiative is a bold call to action around the world’s most pressing health priorities. An example of a grand challenge of our time could be aging and longevity, as highlighted at last year’s annual meeting. I recently distributed a questionnaire to our members in which I asked what you thought were the most important issues for the NAM to focus on. Aging was at the very top.

Through our Grand Challenges initiative, we will spur innovation around this issue and others—marshaling resources and developing collective solutions where the game changing potential is great.

As an academy of health and medicine, we are truly committed to advancing science and increasing its impact on society. In this context, we and the NAS teamed up to launch the Human Gene Editing Initiative. Researchers all over the world are using powerful new gene-editing technologies, which could revolutionize many areas of science and medicine and provide potential treatment and cures for diseases. However, these technologies also raise a number of ethical and social concerns, specifically on the issues of human germline editing and gene enhancement. I am grateful to Keith Yamamoto, Bob Horwitz and Mark Fishman for encouraging the NAM to take on this important and controversial area of science.

We convened an advisory group chaired by David Baltimore and invited the Royal Society and the Chinese Academy of Sciences to join us in holding an international summit last December on the responsible conduct of this research. The summit was attended by representatives from more than 20 countries, was viewed by thousands more worldwide via the webcast, and generated headlines around the world. Currently, a study committee, co-chaired by NAM members Alta Charo and Richard Hynes, is working on a consensus report that will provide a framework and recommendations on responsible gene-editing research that could also be adopted by other nations.

Defining Our Future

As you can tell from all of these examples, our new Academy is on a great trajectory. We’ve already made so much progress over the last year. Where do we go from here?

As a new Academy, we now have the opportunity and responsibility to collectively define our vision, our mission, and our goals for the coming years. Over the summer, we convened an initial working group to formulate the mission statement, with oversight from the NAM Council. This was the first step in a comprehensive strategic planning process.

We reviewed the draft in an expanded leadership meeting in July that included NAM and non-NAM members, and HMD board and committee chairs. Last month, we sent the draft language to all NAM members for feedback. We got a tremendously positive response and many helpful comments.

Now, I am pleased to share with you our new draft mission statement: To improve health for all by advancing knowledge and accelerating progress in science, medicine, policy, and health equity.

Let’s let that sink in for a moment. “Health for all” — the notion of combating health disparities — is built into this statement, as well as the notion that we want to improve health not just domestically, but also globally. Next, we want to both advance knowledge—that means generating new research and finding synthesis in existing research—and accelerate progress—we strive to increase the pace of research and its translation into clinical practice and evidence-based policy decision. Finally, we believe that health equity is a foundational value and an important goal, and decided to call it out specifically in our mission statement. For me, it has been an inspiring and illuminating process to crystallize the essence of our work in this way.

Included in the strategic planning is the consideration of the future of our membership. This is the ideal time to think more deeply about that. Excellence is and always will be the most important criterion for Academy membership. We must capture the excellence that courses throughout the full and diverse range of ages, races, geographic areas, and areas of expertise and, at the same time, anticipate the skill sets and backgrounds that will be needed in the future.

What changes do we need to make? What will our future membership look like? These issues were explored for the first time at a membership policy retreat in March, led by Jane Henney. But any future decisions will no doubt take much time, thoughtful and careful consideration, and engagement with all of you.

One of our goals is to be inclusive of people of diverse generations, cultures, and experiences. As I mentioned, the NAM has several fellowships that bring promising health policy trainees with different background to the National Academies. In addition, through our DC Public Health Case Challenge, we connect with local university students to promote interdisciplinary, problem-based learning around a health issue that faces the DC community.

And, with the help of Marie Michnich, we have just created a Young Leaders Forum, which can be seen on this slide, made up of a dozen young professionals who really represent the future of science, health and medicine. I met with them for the first time yesterday, and we discussed their views on how to involve young leaders in the NAM’s work. I am inspired by their passion and look forward to continuing to work with them in the future. Please stay tuned.

Conclusion

We have covered a lot of ground today — who we are and who we hope to be as an Academy of the future. Yes, the NAM will always be a society of exceptional scholars, scientists, clinicians and leaders. But we are also so much more.

We are an Academy with purpose. We are the nation’s independent, evidence-based advisor for health and medicine. We are collaborative and interdisciplinary. We are a national Academy with a global scope. We are committed to catalyzing action and achieving impact.

No matter what happens in the next election, or in the years after that, we will continue to be the nation’s “truth meter.” We have, for many years, provided evidence-based advice that rises above partisan politics — and we always will.

None of this would be possible without your hard work, your service, and your unwavering dedication to a cause that is bigger than ourselves. We are together today because we know what this Academy can achieve.

As Woodrow Wilson once said, “There is no cause half so sacred as the cause of a people. There is no idea so uplifting as the idea of the service of humanity.” All of us here today recognize the truth in those words.

Ultimately, we are all here today because we want to leave the nation and the world better than we found it. Together, I sincerely believe that we will.