The theme of the National Academy of Medicine’s 52nd Annual Meeting, to be held Oct. 16-17, is Revolutionizing the Biomedical and Health Sciences. NAM President Victor Dzau discusses challenges and opportunities for the health and medicine research enterprise in the decades ahead.

This year’s annual meeting will be a deep dive into big structural challenges that dictate how biomedical science is done — everything from the role of government and the private sector, to education and training, to research funding mechanisms. Why is it important to examine these issues now, at this particular moment in history?

Dzau: We’re celebrating the 50th anniversary of the NAM this year (after a two-year delay because of the COVID-19 pandemic), so we’ve been reflecting on the incredible progress we’ve made in health and medicine in the past few decades — all driven by advances in science and technology. For example, we now have 14 million cancer survivors here in the U.S., which would have been unthinkable even 30 years ago, and heart disease death rates have dropped by almost two-thirds. And, the fact that we could develop, test, and distribute really effective mRNA vaccines for COVID in just 300 days is simply amazing.

So at the NAM, just as we have been advisers and leaders in many of these areas, we are very much focused on our role as leaders in shaping the future. How do we keep these advances coming for the next 50 years? We also have so many exciting new tools and technologies on the horizon that have the potential to really transform science and medicine — such as big data and artificial intelligence, advanced robotics, precise genome editing tools. But I don’t think we’re prepared to fully take advantage of them yet.

And at the same time, we still see tremendous inequality and unequal access to quality health care, especially for society’s most vulnerable. So what can we do to make sure the benefits of science and medicine reach everyone? At the NAM, we are always thinking about these issues. Now is the time to look at the big picture — to imagine the research enterprise we’ll need for the future and what steps we need to take to get there.

As you mentioned, we’ve seen these amazing breakthroughs in so many areas of health and medicine — most of which are based on many years of basic research. But of course, oftentimes, getting from research discovery to diagnostics, treatments, and tools is an incredibly lengthy, risky, and difficult process — with no guarantee of success. What in your view are some of the biggest roadblocks that are impeding innovation?

Dzau: Our overall ecosystem of research, development, and translation is fragmented. It can take something like 17 years, on average, for new discoveries to reach the market and begin to benefit patients. It is so bleak a picture that people refer to this gap as the “Valley of Death.”

In 2010, I wrote a paper for the Lancet in which my colleagues and I described two distinct breaks in the discovery to care to population continuum. First, the gap is from discovery to care, or from bench to bedside. Second, the gap is from positive clinical trial outcome to clinician acceptance and common use, or from bedside to population. For a discovery to be translated, clinically investigated, proven to be effective, disseminated, and adopted in clinical practice, there are multiple handoffs from academic research to clinical development to commercialization to clinical application. These processes are fragmented and slow.

To accelerate the processes, we need to create a streamlined and integrated ecosystem, which allows for efficient transitions across sectors, as well as from discovery to translation to population application. Within the bigger system, academic health science centers have a real opportunity to improve internal efficiency and to act as systems integrators. I believe this is an important next step if we hope to increase our capability of bringing new ideas to patients more quickly and effectively.

Universities and higher education institutions are a fundamental part of our research enterprise, including in terms of educating and training our next generation of physicians, researchers, and health care practitioners. What do you see are two or three of the biggest reforms needed to ensure that U.S. institutions continue to remain innovation hubs and produce the best and brightest?

Dzau: We need to recognize that one discipline is not sufficient anymore to solve complex problems. In health, beyond the biomedical sciences, it’s clear that we need social science, behavioral science, and economics to address our many challenges. What we really need is convergence science — which brings multiple disciplines together not just to collaborate but to actually act as a team, focusing to solve big problems. The university is the natural hub for this, with all of these disciplines existing under its umbrella.

Universities should identify the areas, the themes, and the important challenges for which we need convergence. Take Stanford University, for example, which now has a new School of Sustainability to bring together different disciplines, departments, and institutes to address the global climate crisis. And, of course, this will have lots of implications for the research community, such as how to organize research, how to incentivize teamwork, and how to allocate research funding to support convergence.

Another really important issue for universities and higher education is expanding diversity and inclusion. Science suffers greatly when structural barriers such as racism prevent students from diverse backgrounds from entering or staying in their fields. We need all of the best minds to tackle our biggest problems, which means we must create training and career development paths designed to welcome students of color, as well as those from across a variety of underrepresented groups.

In addition, researchers — particularly younger researchers — spend too much time writing grants and dealing with administrative issues. They are frequently tasked with navigating the scientific ecosystem on their own, meaning they face difficulties in learning how to successfully apply for funding and access the resources and technology necessary to support their projects. Universities must provide the time and career development resources needed for them to be successful, as well as the research infrastructure necessary for them to move efficiently from one stage of research and development to the next.

What can leaders across the research enterprise do to break down barriers and encourage new types of collaboration and multidisciplinary approaches in science and biomedicine?

Dzau: At the upcoming annual meeting, I have organized a special President’s Forum to gather leaders from scientific entities and institutions to discuss this very question. We will hear from leaders in government, philanthropy, higher education, and publishing. For example, Francis Collins, the former director of the National Institutes of Health, will be talking about how our federal research funding enterprise can support great ideas without letting structural issues act as barriers to discovery. Cori Bargmann, head of science emerita at the Chan Zuckerberg Initiative, will explore how philanthropy fills in funding gaps, particularly when a federal agency is not willing or able to take chances on risky research.

Here at the NAM, we are similarly seeking to take risks and embrace bold new ideas. We know that the potential for creativity and progress can exist even without the years of preliminary data that traditional funding mechanisms often require. Our Healthy Longevity Global Grand Challenge is intended to generate and reward innovative research aimed at improving physical, mental, and social well-being for people as they age, and it’s open to participants from any background — not just those with traditional academic training.

We’ll also be hearing from Alondra Nelson, who is deputy director for science and society of the White House Office of Science and Technology Policy and who served for much of this year as OSTP’s acting director. I know one of the topics on her mind will be the incorporation of equity into the research and development process. At the NAM, our Committee on Emerging Science, Technology, and Innovation in Health and Medicine is seeking to understand the societal and ethical implications of emerging science and technologies, and to build a governance framework that reduces the risk these new products create for potential unintended consequences. Similarly, OSTP is considering how best to integrate equity in the development of artificial intelligence and machine learning algorithms to ensure potential end users are protected from threats and that innovations live up to our values of equity, beneficence, fairness, and respect for those they serve.

At the forum, we’ll also be looking at the traditional model of scientific publishing, which has been the gold standard for research dissemination for decades. Recently, conversation on scientific publication has focused on a move toward open access research, as well as how best to evolve traditional publishing to meet the needs of an increasingly forward-thinking and fast-moving scientific community. We’ll be exploring how the field can evolve in order to maintain readership and open doors to new audiences, keep pace with the speed of research, and prioritize scientific integrity in the face of miscommunication and misinformation.

We’ve touched a lot on diversity and equity already, but as you look to the future, what do you think needs to be done differently to ensure that advances in science and health truly benefit all Americans?

Dzau: I have always said that science is here to benefit society, whether the goal of research is to generate knowledge or to inspire discoveries that can improve health outcomes and benefit society as a whole. The problem is that in the midst of these advances, we often see difficulties with affordability, access, and equity. We must address the issue of equity and the societal implications of our work.

Additionally, we know that diversity improves performance and outcomes, which means that we must prioritize building inclusive teams and diversifying the STEM pipeline. The communities affected by scientific advances must be integrated in the research and development process, which means we also need to prioritize community participation and engagement. We need to hear the voices of those we serve, so that we can ensure all patients benefit from the great work we’re doing.