Candidates weigh in on biomedicine

As people wait expectantly for answers from John McCain and Barack Obama to the Science Debate ’08 questions, some clues of what might be coming can be gleaned from the senators’ answers to a written questionnaire sent the candidates by Research! America. This group bills itself as the nation’s largest not-for-profit public education and advocacy alliance. It should be noted, however, that the Alexandria, Va.-based group has a definite bias. It’s stated mission: “making research to improve health a higher national priority.”

Earlier this week, I spoke with Stacie M. Propst, the organization’s vice president for science policy and outreach about McCain and Obama. “There are some commonalities between the candidates that come through loud and clear,” she said. “Both would shift to a health-care system that addresses and preempts disease.” Both also value research as the foundation of innovation, back stem-cell research (though McCain with caveats), want to reform the H-1B visa program to allow in more non-immigrant foreign workers with specialty skills (that include but are not limited to engineering, mathematics, physical sciences and medicine), and favor digitizing medical records to streamline costs and limit medical errors.

“We do a lot of opinion research,” Propst says, “and we started to see a trend emerge from the public — that although Americans say they would back a candidate who supports greater funding for research, they don’t actually know that much about the positions on this by their elected officials and candidates.”

Obama sent in his responses to Research! America’s 17 questions late last year. McCain’s answers arrived much later — this summer. The group also has responses from Chuck O. Baldwin (the Constitution party candidate from Palmyra, N.Y.), Rep. Bob Barr (the Libertarian party candidate from Atlanta), Rep. Cynthia McKinney (the Green party candidate from Atlanta), and Ralph Nader (the Independent candidate from Washington, D.C.).

You can view the whole list of responses on the group’s website. Below, I’ve digested what seemed the salient elements of responses from Obama and McCain for people who are more generally interested in the research.

Research America’s Questions to Presidential Candidates

What’s your view of our current health care system?

Obama: He says the system is broken and needs a complete overhaul. “My plan will: (1) establish a new public insurance program, available to Americans who neither qualify for Medicaid or State Children’s Health Insurance Program (SCHIP) nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) create a National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees or towards the cost of the public plan ; (4) mandate all children have health care coverage; (5) expand eligibility for the Medicaid and SCHIP programs; and (6) allow flexibility for state health reform plans.” McCain: “The biggest problem with the American health care system is that it costs too much.” Would provide families with $5,000 refundable tax credit to purchase insurance of their choice; ensure insurance is portable — not linked to job; invest in research promoting new treatments and wellness strategies.

How would you increase a focus on prevention and wellness?

Obama: His program “commits to promoting healthier lifestyles in schools, the workplace, and the home, as well as preventive services, disease management, care coordination, and other efforts. Too many Americans go without high‐value preventive services, such as cancer screening and immunizations to protect against flu or pneumonia. Providers are not adequately reimbursed for helping patients manage chronic illnesses like diabetes or asthma. . . . Our health care system has become a disease care system, and the time for change is well overdue.” Initiating a focus on prevention and wellness “is a critical part of my health care plan.” McCain: Insurance should “reward and encourage healthy behavior,” such as offering “reduced premiums for healthy lifestyle behavior as well as surcharges for individuals who continue to elect proven unhealthy lifestyle behaviors.” Would also support wider implementation of stop-smoking programs; fight childhood obesity through programs designed at the local level that might include “removing [school] vending machines, providing healthy, low fat menus in school cafeterias, and providing more physical education and recess opportunities.

What’s your opinion on current funding for the National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and the Food and Drug Administration?

Obama: The U.S. must “increase funding for NIH, CDC, AHRQ and FDA. In particular, “FDA is badly underfunded for its responsibilities. As our economy brings a rising tide of imported products, the FDA urgently needs expert staff and technology to more rigorously inspect imported food, drugs, and other products like pet food. The FDA must also be freed from the Bush Administration’s ideological straightjacket to protect the public health on the basis of sound science. As president, I will end the delays in approving RU‐486, the pressures to silence internal drug safety critics, and the attempts to protect drug companies from product liability.” McCain: “I strongly support funding” for NIH, CDC, AHRQ and FDA.

How important are U.S. efforts to improve health globally?

Obama: “America’s security is strengthened when we strengthen those weak states that are at risk of collapse, economic meltdown or public health crises. As president, I will double U.S. foreign aid assistance by 2012, and ensure that we work with other nations to improve international public health.” McCain: “[By] helping provide medical care and public health interventions in areas of need, we will contribute to a more peaceful and stable world and foster a more positive view of the United States while safeguarding our nation’s health and strengthening our national security.

Do you support or oppose increased federal funding for state/local health departments and hospitals that are expected to prepare for and respond to threats to our health?

Obama: “Our public health departments’ workforce and finances are stretched too thin to carry out traditional public health functions, such as ensuring our water is safe to drink, the air is safe to breathe, and out food is safe eat. These traditional public health functions have evolved to include responsibility for disaster preparedness and responding to both natural and man-made disasters. Accordingly, I will champion a renewed focus and the necessary resources to improve public health and prevention.” Moreover, “the field of public health would benefit from greater research,” recruitment of more trained personnel, and “modernizing our physical structures, particularly our public health laboratories.” McCain: As health departments and hospitals “are our first line of response against public health threats, both natural and man-made – everything from a flu outbreak to bioterrorism . . . [w]e need to ensure that there is an important focus on developing a strong regional and national strategic plan that focuses on better coordination, improved communication capabilities, and greater accountability.”

How would you characterize and prioritize the apparent shortages and/or poor distribution of certain health care professionals — physicians, nurses, and dentists?

Obama: Creating incentives to recruit well qualified people into these fields is “a top priority.” McCain: “I will ensure that there are proper incentives in place to address the workforce shortage.” These might include: encouraging more scholarships and loan programs to ensure greater health-care staffing in areas (like primary care) with critical shortages through appropriate funding of programs like the National Health Service Corps, ensuring diverse practitioners are available “to provide culturally component care,” and offering more training internships and fellowships at centers such as NIH and CDC.

Do you support or oppose expanded federal funding for research using embryonic stem cells?

Obama: Stem cells hold the promise of treatments and cures for more than 70 major diseases — conditions affecting more than 100 million Americans. “As president, I would: promote embryonic stem cell research” (as he did when he introduced legislation as a member of the Illinois Senate “that specifically permitted embryonic stem cell research in Illinois”). He would also expand the number of stem cell lines available for research. He cosponsored the current Stem Cell Research Enhancement Act. “My plan would reverse the president’s policy that has allowed hundreds of thousands of frozen embryos, left over from in vitro fertilization, to simply be discarded.” McCain: ““While I do support federal funding for embryonic stem cell research, I also believe that clear lines should be drawn to reflect a refusal to sacrifice moral values and ethical principles for the sake of scientific progress. Moreover, I believe that recent scientific breakthroughs raise the hope that one day this debate will be rendered academic. I also support funding for other research programs, including amniotic fluid and adult stem cell research which hold much scientific promise and do not involve the use of embryos. I strongly oppose the intentional creation of human embryos for research purposes. I voted to ban the practice of ‘fetal farming,’ making it a federal crime for researchers to use cells or fetal tissue from an embryo created for research purposes.”

Should mental health services be part of all public and private health-care plans?

Obama: “I am a long-time supporter of mental health parity. I helped pass the Illinois mental health parity law. And my national public health plan will include coverage of all essential medical services, including preventive, maternity and mental health care.” McCain: “I support mental health parity to ensure that mental health coverage is on par with medical and surgical benefits.”

Comparative-effectiveness research compares two alternative treatments to see which works better for the average patient. Many feel Medicare and private insurers should only cover the most effective treatment. Others feel that since comparative effectiveness only determines which treatment works best on average, the ultimate decision as to what treatment should be left to doctors. What’s your view?

Obama: “One of the keys to eliminating waste and missed opportunities in our health care system is to increase our investment in comparative effectiveness reviews and research.“ McCain: “Although comparative effectiveness research holds great promise in helping us [improve the value of health care spending] by better informing us about effectiveness of treatments, we need to ensure that this does not stifle the spirit of innovation in our medical sciences . . . and maintains patient choice.”

Is the U.S. in danger of losing its global competitive edge in science, technology and innovation?

Obama: “[T]he U.S. has the potential to lose its global competitive edge in science, technology and innovation unless we take steps to change the current trend.” He’d double federal funding for basic research in the physical sciences and engineering research; make the R&D tax credit permanent; produce more math and science graduates (especially women and minorities) and encourage more of them to do graduate work; reform the visa programs (including the H-1B program) to attract some of the world’s most talented people to America. Would also bring “true broadband” to every community in America through a combination of reform of the Universal Service Fund, and make better use of the nation’s wireless spectrum. McCain: ““I am committed to federal policies that ensure America’s competitive edge . . . Maintaining our tech edge requires robust basic research and sustained development efforts. I will support innovation by funding basic research and reforming and making permanent the R&D tax credit. We also need to keep the Internet tax-free.” He is also “a strong supporter of H-1B expansion”. H-1B “reforms should eliminate the artificial limits and allow the Department of Labor to set a level of visas appropriate for market conditions.”

Janet Raloff is the Editor, Digital of Science News Explores, a daily online magazine for middle school students. She started at Science News in 1977 as the environment and policy writer, specializing in toxicology. To her never-ending surprise, her daughter became a toxicologist.

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