“A Little Disturbance” In The American Academic Biomedical Ecosystem
By
Leonard Zwelling
On March 7, I was privileged to attend an all-day symposium to honor my wife, Dr. Eugenie Kleinerman. It was sponsored by the Division of Pediatrics, an academic patient care and research unit she headed for 14 years. The primary reason for this event is her stellar career in research, clinical care, and teaching. It was a grand occasion filled with great scientific talks and a great deal of gratitude for her work.
But it was also something else.
The collective presentations of the speakers were a microcosm of the American academic biomedical ecosystem loaded with examples of the benefits of that system. That system consists of MDs and PhDs who are trying to understand the origins of human disease, in this case osteogenic sarcoma, and formulate ways to eradicate cancer and relieve human suffering from this malignancy. What characterizes this ecosystem?
First, its location is in institutions of higher learning with medical schools and research labs and hospitals, medical students and trainees, laboratories and clinics.
Second, the ecosystem’s heart is the physician-investigator who can perform experiments in the lab and apply the results to improve patient care through thoughtful clinical trials. All of the speakers and the honoree at the Kleinerman Symposium were physicians. All of the talks, even those filled with laboratory observations, had one eye on helping the patient with osteosarcoma.
Third, the real reason for the symposium was Dr. Kleinerman’s seminal observation that immunotherapy can be used to successfully treat osteosarcoma.
Okay, that’s enough of my bragging.
It is quite clear by now that the Trump Administration has no respect for this ecosystem. Whether it is the world of vaccines (how much money is the CDC about to waste searching for a vaccine-related cause for autism), research grant funding, or education, this administration’s hostility to academia is beyond question. The actual impact Elon Musk has had on the NIH has not yet been totaled. Grant funding has been on hold and the indirect cost rate will be cut. The new head of NIH may be smooth in front of the Senate, but what will be his impact on this ecosystem? Will it be nurturing or will he take a chain saw to the greatest system to alleviate human suffering ever devised?
No country in the world has the access to novel medicines that the U.S. has. The driver is obviously, in part, profit. A fair debate can be had as to whether there is price gouging in the system and why the drug companies spend more on marketing than they spend on research. But, there can be no denying that the engine driving the new discoveries that make such drugs possible is the academic biomedical ecosystem where many of the most important discoveries are made.
But that ecosystem must have stable and predictable funding. That means at least a constant NIH budget and a fair and transparent determination of what indirect costs ought to be. It will also mean some attention to the next generation of physician-investigators. Where will they come from? Will a career in biomedical research even be attractive to young people if there is no money to support such a career because of government cuts?
Donald Trump has succeeded in waking the country up from its complacency. That includes the academic biomedical ecosystem. We in the system (yes, I’m retired but I’m writing this aren’t I?), are worried. Not only has medicine suffered a loss in status as a profession among young people, research will as well if funding cannot be depended upon.
I know Mr. Musk likes rocket science. I wonder if he has any respect for biomedical science. I guess we are about to find out.
