Professor Aaron S. Kesselheim, MD, JD, MPH, delivered a powerful congressional testimony to the United States House of Representatives last month in Washington DC advocating for the appropriate funding and drug price negotiation of pharmaceutical innovation and medications for patients. Addressing the Health Subcommittee of the Ways and Means Committee, he offered a three-pronged testimony urging Congressional support of National Institute of Health (NIH) medical research funding, policy interventions to bring effective and affordable medical treatments to patients, and the recognition of vaccines and biosimilars as vital tools in public health through equitable distribution. Dr. Kesselheim testified that "cutting Medicaid funding would threaten medical innovation and jeopardize access to lifesaving care for patients," calling on Congress to strengthen healthcare access as a means of improving health outcomes nationwide.
As a trained internal medicine physician and attorney, Dr. Kesselheim brought a unique interdisciplinary perspective to his testimony, advocating for affordable medications through the lens of his extensive background in medicine, public health, and law. Currently serving as a Professor of Medicine at Harvard Medical School within the Division of Pharmacoepidemiology and Pharmacoeconomics of the Department of Medicine at Brigham and Women’s Hospital, he also leads the Program on Regulation, Therapeutics and Law (PORTAL), a research center focusing on the affordability and efficacy of medicines through policy interventions and the development and pricing of drugs. Dr. Kesselheim continues to share his expertise through the HMS Center for Bioethics, where he co-teaches the Health Law, Policy, and Bioethics Course in the Master of Science in Bioethics (MBE) program and organizes the monthly policy and ethics consortium. Despite his extensive academic and research responsibilities, he remains actively engaged in shaping health policy by providing consultation to legislators and policymakers on aspects of pharmaceutical law and policy that significantly affect patient access to medications, especially in light of today’s politically volatile environment.
As mentioned in the second hearing regarding “Lowering Costs for Patients: The Health of the Biosimilar Market” members of the Health Subcommittee raised concerns about the current administration’s “attack on science, on research, the Food and Drug Administration, and the National Institutes of Health”, spurring proposals cutting additional funding from programs bringing drugs like biosimilars to patients who need them most. In his testimony, Dr. Kesselheim called out current bills under consideration like the Ensuring Pathways to Innovative Cures (EPIC) Act, Optimizing Research Progress Hope And New Cures (ORPHAN CURES) Act, and Maintaining Investments in New Innovation (MINI) Act, which would, in his words, “…exclude and delay drugs from negotiation and keep prices excessively high” further restricting access to treatments.
Passionately, he highlighted the ways in which government programs like Medicare negotiate prices for and fund prescription drugs for populations who cannot afford them on their own. Yet under the guise of "efficiency," proposed cuts to Medicare and related government programs would primarily benefit wealthy pharmaceutical companies at the expense of underserved and vulnerable populations. Dr. Kesselheim urged policymakers not to widen the gaps in scientific advancement and patient access that are already being exacerbated by an intentional weakening of public health infrastructure by advocating for patients across the U.S. In doing so, Dr. Kesselheim set an incredible example for the necessity of researchers, students, faculty, and clinicians to advocate for their work at the policy level and the importance of centering bioethical standards in all efforts towards healthcare reform. When asked about how he advises others to share their work to influence policy change, he shared:
“It’s very important to take communication seriously and work on actively disseminating your work to potentially interested policymakers, as well as to work on trying to ensure that the main messages of your work are communicated to patients. That can be through blogs, op-eds, podcasts, interviews … there are a lot of avenues available.”
Specifically, as the regulation and control of healthcare, pharmaceutical, and public health oversight are in flux with the current administration, Dr. Kesselheim mentioned the dangers of allowing space for misinformation and anti-vaccine rhetoric to take place in a public health context. Further sharing, he mentioned that: “If good scientists step back from communication, that will leave more room for the anti-vaxxers and others pushing a misinformation agenda.” Dr. Kesselheim’s words leave a lasting message: it is equally as important for scientists to produce good work as it is for them to disseminate their findings in a way that others can understand, in order to encourage trust in a time when even the oldest of political institutions are seeming more and more untrustworthy.
Dr. Kesselheim’s work in drug policy reflects the bioethical considerations that are inextricable from vaccine-related policy decisions, including their development, distribution, informed consent, and the balance between individual rights and public health. In his Congressional testimony, he highlighted how the discovery of new vaccines was only made possible through the central role that the National Institutes of Health (NIH) have played in their development, from translational studies to proof-of-concept testing in laboratories. With the current administration pushing cuts to programs vital to therapeutic innovation, his defense of vaccines and prescription drugs as some of the most impactful and cost-effective medical interventions available for distribution comes at a critical political moment. Dr. Kesselheim’s testimony emphasizes that Congress could help patients benefit from these medical interventions by supporting development at a time when science itself is under threat from lawmakers who exploit public health tools for political purposes. He further commented:
"Effective vaccines have been taken safely by billions of people around the world. The current US government’s actions are threatening to roll back the substantial amount of progress we’ve made as a society against deadly infectious diseases both by reducing the availability of those effective and safe vaccines and reducing people’s willingness to trust their physicians’ recommendations to use them."
Amid this climate of rampant misinformation, Dr. Kesselheim stressed that it is incredibly important for academics and nonacademics alike to look to trusted sources for guidance on life-saving medications and interventions. When asked how he recommends keeping up with the ever-shifting policy landscape, he advised: “It’s very important to identify trusted sources of information to help with patient decision-making. The government used to be a place you could confidently get good information from, but unfortunately the current administration appears to be moving to undermine that role as quickly as possible. As new information sources arise, people should talk to their physicians and look for information disseminated by physician professional societies like the Infectious Diseases Society of America."
As the nation confronts growing uncertainty over whom to trust in positions of public authority, it is important to remember that there are professionals across disciplines who are working to keep ethical perspectives at the center of their efforts. While it is not uncommon for legislation to include provisions that inadvertently affect the most vulnerable, experts like Dr. Kesselheim continue to show the vital role that scientists and healthcare providers can play in working together with policymakers to prevent further inequity. By shaping policy to reflect the bioethical responsibility of public servants, we can work towards a world where life-saving medications are able to reach the patients they were designed to help.