Science - 06.12.2019

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SCIENCE 6 DECEMBER 2019 • VOL 366 ISSUE 6470 1179




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.


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


By Jocelyn Kaiser

2012 2013 2014 2015 2016 2017 2018 2019








Commitments ($ millions per 8scal year)


Infrastructure Patient

Dissemination and

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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