COMMENTARY

Two Bright Lights on the Healthcare Horizon

Jeffrey A. Lieberman, MD

Disclosures

August 12, 2015

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Hello. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you for Medscape.

In July, two pieces of legislation progressed through the legislative process in Washington. These bills represent bright lights on the horizon in what otherwise has been a dark period for healthcare in this country, particularly in mental health care and biomedical research funding.

The 21st Century Cures Act

The first bill is the 21st Century Cures Act, which was developed by Representatives Diana DeGette from Colorado and Fred Upton from Michigan. This bill will substantially increase the funding for the National Institutes of Health (NIH) over the next 5 years in specific areas of emphasis and in general. In addition, it will streamline the FDA review and approval process to facilitate the development of new and more effective treatments. Both aspects of this bill could revitalize the nation's biomedical research community, which has been in dire straits and consistently eroded during the past decade because of increasing costs and burdensome regulatory and approval processes. The decline in funding of the NIH and in efforts by the pharmaceutical and biotech industries to develop new treatments has particularly affected the development of treatments for central nervous system disorders, especially those that involve mental illnesses.

On July 10, this bill was passed in the House by a unanimous vote, but it has to go through the Senate and be signed into legislation by the President. Although no one is opposed to better and less expensive treatments or more funding for biomedical research, some are concerned that, given the budget deficit and the need to be fiscally responsible, funding cannot be increased in one area without reducing it in another area. The question is, in what areas should funding be reduced?

I hope that reason will prevail and a way will be found to advance this legislation and renew a starved biomedical research community, a community that has been systematically eroded with a sustained period of underfunding. This is particularly a concern because Europe and Asia have been allocating increasing proportions of their budgets and gross domestic product to biomedical research and development, whereas our funding in the United States has remained stagnant or has declined.

The Helping Families in Mental Health Crisis Act

The second piece of legislation that represents a hope for us in the mental health care community and psychiatry is the Helping Families in Mental Health Crisis Act, which has been introduced by Representatives Tim Murphy of Pennsylvania and Eddie Bernice Johnson of Texas. This bill is a potentially transformative mental health care legislation, the most significant since the Mental Health Parity and Addiction Equity Act of 2008. It would enhance the assurance that services provided in the public sector, services that receive support from the federal government largely through the Substance Abuse and Mental Health Services Administration (SAMHSA), would need to be scientifically driven and evidence-based. The bill also includes elements to consolidate the oversight of mental health care and research within the federal government by appointing an assistant secretary for mental health and creating a national research laboratory to review research findings that have reached the threshold of translation into clinical practice.

This legislation moves mental health care forward in a way that has been needed for a long time but for various reasons has not been achieved. It includes some controversial elements, but these should not prevent the bill's passage. My hope is that Congress will work through their differences and come together in a bipartisan way to support and pass the Helping Families in Mental Health Crisis Act, as well as the 21st Century Cures bill.

To the degree that you are engaged in the political process or are inclined to at least communicate with your representatives and senators, I urge you to encourage them to support the 21st Century Cures Act and the Helping Families in Mental Health Crisis Act. As physicians and healthcare providers, we must not only do a good job with our patients and stay current with the scientific literature, but now we must also engage in some degree of political activism because, frankly, all of the knowledge we have and the treatments we can use are only as good as the policies that fund and support them.

Thank you for listening. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you today for Medscape.

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