Thursday, June 13, 2024

NIH's budget woes hit cancer trials

The ideas and innovators shaping health care
Jun 13, 2024 View in browser
 
Future Pulse

By Toni Odejimi, Ruth Reader and Daniel Payne


WASHINGTON WATCH

CAMBRIDGE, UNITED KINGDOM - DECEMBER 09:  A Scientist looks at cells through a fluorescent microscope at the laboratories at Cancer Research UK Cambridge Institute on December 9, 2014 in Cambridge, England. Cancer Research UK is the world's leading cancer charity dedicated to saving lives through research. Its vision is to bring forward the day when all cancers are cured. They   have saved millions of lives by discovering new ways to prevent, diagnose and treat cancer, and as such the survival rate in the UK has doubled in the last 40 years. Cancer Research UK funds over 4,000 scientists, doctors and nurses across the UK, more than 33,000 patients who join clinical trials each year and a further 40,000 volunteers that give their time to support the work. (Photo by Dan Kitwood/Getty Images/Cancer Research UK)

The National Cancer Institute is grappling with how to expand research amid budget constraints. | Getty Images

The typically flush National Cancer Institute is trying to learn how to do more with less. NCI Director Dr. W. Kimryn Rathmell spoke to the tightened budget during a NCI advisory board meeting Wednesday, in which leaders grappled with how to expand its research in the face of a tight budget.

Why it matters: Clinical trials allow scientists to offer potentially lifesaving care to patients who are out of treatment options.

The advisory board discussed how best to offer access to underserved groups, such as a lung cancer clinical trial to obtain more data from minority patients. Dr. Nilofer Azad, chair for the subcommittee on clinical investigations at NCI, and her team also want to decrease barriers to trial enrollment.

However, they can’t do that effectively without adequate resources.

By the numbers: In 2023, President Joe Biden’s cancer moonshot,a program that strives for a 50 percent reduction in cancer deaths over 25 years, saw its funding end. While Congress gave NCI a $120 million boost to its base budget in fiscal year 2024, the institute is still short $96 million, said M.K. Holohan Quattrocchi, director of the Office of Government and Congressional Relations at NCI.

Congress didn’t re-up funding in 2023 for the 21st Century Cures Act, a law that granted funds mainly to the National Institutes of Health. Quattrocchi said that while some proposals force mandatory aid to moonshot, it may be difficult to make that happen due to the Fiscal Responsibility Act passed last year. That act suspended the debt ceiling and reduced the amount of discretionary spending for organizations like NCI.

What’s next: The National Cancer Institute will host its first annual retreat in July for leadership to look at gaps in data and address public comments.

 

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This is where we explore the ideas and innovators shaping health care.

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PROBLEM SOLVERS

A screenshot of Alma's online platform

Alma’s new AI assistant is built to reduce therapists’ workloads. | Courtesy of Alma

AI can now assist therapists. Alma, a company that makes a tech platform that helps therapists with everything from finding new patients to insurance billing, has launched an AI assistant.

The assistant transcribes therapy sessions and then pulls out insights, creating clinical notes for therapists and potentially reducing their workload.

Several AI notetakers for doctors are on the market, and health systems are experimenting with using them. But there’s no clear evidence that the tools make a dent in doctors’ to-do lists. Physical health care visits might not be well suited to AI clinical note-taking.

“A lot more of a medical visit is what I observe than what I say or we discuss,” Alma CEO Harry Ritter, who trained as a physician, said. But talk therapy offers a richer dataset, he said.

Why it matters: Like medical doctors, therapists might not be able to record their clinical notes until the end of the day, which can stretch their ability to remember what occurred during their sessions.

Elisabeth Morray, head of clinical operations at Alma, said she had tried several AI notetakers and was skeptical about their usefulness. But Alma’s is adept at identifying the interventions she used and highlighting themes that came up during sessions.

“When the AI is dealing with this input, it can follow multiple different threads that, on my own, I wouldn’t be able to track and certainly not remember well enough to put into my note,” she said.

Privacy concerns? As Ritter pointed out, recorded therapy sessions are rich datasets with highly personal information. Morray said patients must sign a release agreeing to be recorded. The company doesn’t keep recordings once they’ve been analyzed.

Health systems and data companies are frequent targets of cyberattacks, as the February breach of UnitedHealthcare’s payments processor, Change Healthcare, shows. As companies make their data more useful, they become more enticing to hackers.

 

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DANGER ZONE

Antony Haynes

Haynes sees new cybersecurity threats in the AI age. | Courtesy of Dorf Nelson & Zauderer LLP

Health systems often focus on the benefits of advanced artificial intelligence — but serious cybersecurity risks come with the new technology.

How so? AI has opened new vulnerabilities and supercharged attackers’ tools to access health systems, Antony Haynes, partner and head of Dorf Nelson & Zauderer’s Cybersecurity, Data Privacy and A.I. Practice, told Daniel.

Fake emails or phony calls have long been used to trick employees into giving over sensitive data or credentials to log into internal systems — but language-focused AI has made it possible to convincingly automate those spoofs.

Some tools that hackers use, such as so-called password crackers, are much more powerful with AI.

And health systems’ own AI programs can sometimes be tricked into offering up personal health data.

Haynes said hackers’ access to AI is like adding wings to a tiger: “A ferocious predator has been made even more terrible.”

Even so: Haynes said health systems can check that they’re meeting industry and regulatory standards for cybersecurity, as well as create and run tests on plans to react to a breach — processes he and his team help clients through.

Why it matters: Health systems have been particularly focused on the threat of cyberattacks in the months following the breach at Change Healthcare, which got the attention of providers and lawmakers alike.

Mishandling data security could not only mean big financial losses but also more scrutiny from regulators.

 

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