Science - 6 December 2019

SCIENCE sciencemag.org 6 DECEMBER 2019 • VOL 366 ISSUE 6470 1179

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; (DATA) PCORI

grant calls and distribute its limited funds ef-

ficiently and transparently, Bellomo says.

The current bill says ANR’s annual budget

would start with €25 million in 2020, and

rise to €200 million in 2021 and €300 million

in 2022. It would fund “innovative” projects,

help coordinate research at universities and

public agencies, and promote Italy’s partici-

pation in international projects.

The bill also says ANR will be an indepen-

dent agency working “under the supervi-

sion” of the prime minister and the research

minister. Most appointments to the agency

would be political: The prime minister

would select the director, and the politically

appointed ministers of several govern-

ment agencies would appoint five of the

eight members of the ANR executive board.

“That’s very troubling,” says Alberto Baccini,

an economist at the University of Siena, who

worries that political appointees could steer

funds to fit an ideological agenda. To safe-

guard the agency’s political independence,

Baccini says scientists should elect at least

some of its management. Others hope an

international search committee would select

experts to ANR’s executive board.

The head of MIUR’s technical secretariat,

Fulvio Esposito, who helped write the draft

bill, admits that the current proposal is a

hastily written outline for the new agency.

Esposito says MIUR is trying to get the Parlia-

ment to simplify the bill so that it establishes

the agency without specifying how it will be

staffed and run. That would allow MIUR of-

ficials to spend time studying the structures

and funding models of research agencies in

other developed countries and gather feed-

back from Italian researchers.

James Wilsdon, a science policy researcher

at the University of Sheffield in the United

Kingdom, cautions that adding another fund-

ing organization, which could take years to

set up completely, might not be the best way

to boost Italian research. Wilsdon also wor-

ries that friction about ANR’s structure could

become a distraction from increasing Italy’s

overall research spending, “which is clearly

what’s required.” Although €300 million

won’t propel Italy past other nations, he says

it’s a nontrivial amount, and that it’s sensible

to start small, see what works, and scale up.

Others are more optimistic. The creation

of ANR signals an ambition to turn around

the fortunes of Italian research, says molecu-

lar biologist Rosario Rizzuto, president of the

University of Padua. If adequately structured

and funded, Rizzuto says, the agency can be

“a good opportunity to boost investments

that are necessary for the economic growth

of our country.” j

Giorgia Guglielmi is a journalist in

Cambridge, Massachusetts.

P

atients and their doctors face crucial

choices every day: Surgically excise

precancerous breast cells or watch

carefully for growth. Try meditation

for anxiety or go with prescription

drugs. Stay in the hospital for tests

after chest pain or head home and have

testing later. To help with such decisions,

and to rein in U.S. health care costs, Con-

gress 9 years ago created an independent

research institute that would enlist pa-

tients as partners in designing studies that

compare the benefits of established medi-

cal treatments.

Now, after awarding nearly $2.6 billion

for research, the nonprofit Patient-Centered

Outcomes Research Institute (PCORI) in

Washington, D.C., faces a turning point.

The agency’s charter was set to expire on

30 September, and it is operating under a

temporary extension until 20 December.

Congress must decide whether to reautho-

rize the organization long term, and if it

does, whether to fine-tune its mission.

Supporters say it’s obvious that PCORI

should continue. With annual incoming

funds averaging about $480 million since

2014, the operation has paid for more than

700 projects, more than half completed by

now, that are already influencing health

care. “We’re starting to see results that really

matter,” says Christine Goertz, a health ser-

vices researcher at Duke University in Dur-

ham, North Carolina, who chairs PCORI’s

governing board.

In spite of complaints that PCORI was

slow to launch large randomized trials that

could sway medical practice and cut costs,

disease advocacy and research groups

back it. “They have picked up speed and

set up more effective studies. What they’re

doing now is what they should be doing,”

says Ross McKinney, chief scientific officer

for the Association of American Medical

Colleges, based in Washington, D.C.

Lawmakers seem to agree—bipartisan

bills in the House of Representatives and

Senate would reauthorize PCORI for as

long as 10 years. But with a crowded leg-

islative calendar and impeachment taking

lawmakers’ attention, it’s not clear when a

bill will be passed.

PCORI’s birth took political compro-

mises. Congress created it as part of then-

President Barack Obama’s 2010 Affordable

Care Act, funding it largely from a tax on

health insurance plans that goes into a

trust fund. Backers reasoned that “com-

parative effectiveness research” could help

control ballooning medical costs. Conserva-

tives worried, however, that PCORI’s work

would result in health care rationing, so

Institute that aims to reshape

health care seeks renewal

Mixed reviews for effort to compare medical treatments

MEDICINE

By Jocelyn Kaiser

2012 2013 2014 2015 2016 2017 2018 2019

0

100

200

300

400

500

600

Commitments ($ millions per 8scal year)

Comparative

e2ectiveness

Infrastructure Patient

engagement

Dissemination and

implementation

Methods and

other research

Spend a little, save a lot?

By funding studies that compare treatments, the Patient-Centered Outcomes Research Institute

promises to control health care costs.

Published by AAAS

on December 12, 2019^

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