Work described in this story was made possible in part by federal funding supported by taxpayers. At Harvard Medical School, the future of efforts like this - done in service to humanity - now hangs in the balance due to the government's decision to terminate large numbers of federally funded grants and contracts across Harvard University.
- By JAKE MILLER
When Nicole Maestas was appointed chair of the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School less than a year ago, she was eager to find ways to amplify the work the department had been doing to help address some of the most significant threats to the health and well-being of the nation.
Instead, with proposed reductions in federal funding for research nationwide and the termination of government grants and contracts for research at Harvard, Maestas is now looking for ways to keep this crucial research alive.
Harvard Medicine News spoke with Maestas about what lies ahead.
Harvard Medicine News: What kind of research is at risk with the current cuts?
The projects that hit me most viscerally are two contracts that health care policy faculty members have with the Department of Veterans Affairs that we just learned were proposed for cancellation.
The first is for work on a new tool designed to help VA emergency room physicians decide whether veterans with thoughts of suicide should be hospitalized. That project is led by Ronald Kessler, the McNeil Family Professor of Health Care Policy at HMS, and it builds on decades of work he's done helping the Department of Defense address the mental health needs of soldiers and veterans.
The second is a project to evaluate cancer care at non-VA health facilities that work with the department to treat veterans. That's led by Nancy Keating, professor of health care policy at HMS, who studies how provider, patient, and health system factors affect the quality of care people receive for cancer.
The idea of stopping this work is just shocking. There are lives on the line.
HMNews: What other challenges are researchers in the department trying to solve?
Many of our scientists are engaged in research that is just as crucial but with a longer timeline: how to fix the way we pay for and provide health care in this country.
It may not seem as urgent at first glance, but behind the dollars and spreadsheets, human health and lives are at stake. We're facing unsustainable growth of spending, and there are millions of Americans who don't have access to the medical care they need either because they can't afford it or because they live somewhere where there are no doctors or hospitals. This is a slow-motion catastrophe that also costs lives.
HMNews: It sounds like there's a lot we need to do to improve health care in this country. How does research help?
A recent report from the Commonwealth Fund ranked the United States last among 10 industrialized nations in the quality of our health care systems. Even though the United States spends more per person than any nation in their sample for health care, we die the youngest and live the sickest lives.
Some of our researchers look at how the whole system functions, and some focus on more specific aspects that are especially pressing right now, like how we will care for our aging population and how we can tackle the unmet need for mental health care.
HMNews: So how are we going to fix all those problems?
It's a big challenge. It all starts with having information we can trust to inform the decisions we make. Outcomes are truly predicated on solid evidence. Without such evidence, any measures we take would be misguided. This is the kind of information our studies are designed to provide. Our faculty members advise government and industry leaders at the highest level, and our graduate students become the leaders of tomorrow.
HMNews: Why is it so hard to figure these things out?
You've probably heard people talking about "building the plane while flying."
We're trying to measure the plane, figure out where it's headed, and understand how it flies, all while swapping out the engine and the rudder that steers the plane.
To make things even more complicated, the materials the plane is built out of are things like politics, ethics, economics, clinical medicine, and psychology.
We have an amazing team of creative researchers who are inventing new ways to get the data they need from clinical and insurance payment records that were never meant to answer the questions we need to ask, and a brilliant team of statisticians who are constantly pushing the frontiers of statistical methods and machine learning to help find the answers.
All that work and all this brain power are now jeopardized by the funding cuts.
HMNews: What helps you keep focused and centered with all this going on?
I am spending a lot of time in my garden.
I get out to the yard, and I feel like, OK, I can control where the plants go and when the seeds are planted. I can do my best to give them the water, the nutrients, and the light they need. If I do those things, the plants grow. It's not always easy, and things don't always go the way you plan. But the seasons come and go, and if you're willing to dig in and get your hands dirty, beautiful things will happen.
It's nice to be in the garden, but I think those are also good lessons for anyone who's working to protect the lifesaving science we do.
This interview has been edited for length and clarity.
