One of four scientific presenters, Linehan told dramatic war stories, all about how he and his patients fight hereditary kidney tumors.
He spoke of rewarding successes: One study helped provide the foundation for development of 6 FDA-approved drugs.
He lamented “humbling” failures: One particularly aggressive form of kidney cancer kills 100 percent of people who develop advanced disease.
He waxed on about being able to switch gears when he needed to, about not being required to hew to traditional treatments, about being encouraged to set new standards for care.
Throughout it all, though, he boldly sang the praises of the unique institution that is the Clinical Center and the unequaled intellectual nourishment and freedom such a community provides.
“Here they respect ideas,” said Linehan, chief of NCI’s Urologic Oncology Branch and a nearly 30-year veteran NIH clinical investigator. “Here you could turn on a dime. Here, if you have a good idea and want to pursue it, you can do that.”
Truth is, NIH doesn’t have enough Linehans.
Expanding the Niche
|Dr. Charles Sawyers of Memorial Sloan-Kettering Cancer Center
|NHGRI scientific director Dr. Daniel Kastner
|Dr. Christine Seidman of Harvard Medical School
As long ago as 1979, NIH realized its clinical researcher population was dwindling. In fact, then NIH director Dr. James Wyngaarden observed in an article that clinical investigators were becoming “an endangered species.”
More than 30 years later, NIH director Dr. Francis Collins said, they’re still “a vanishing breed.” He pointed out several reasons their ranks have continued to shrink:
- long training course
- large debts physicians acquire
- absence of protected time to conduct research
- environments not conducive to “big thinking.”
Time to “expand the niche,” Collins said, adopting evolutionary terms. “That’s what we’re trying to do here with the NIH-Lasker Clinical Research Scholars Program—provide a chance in a very competitive atmosphere for the best and brightest of physician- scientists to come here for an opportunity to explore those big ideas that can happen in unique ways, with the fantastic facilities of the Clinical Center and the minds of the 7,000 doctoral-trained individuals on this campus who are experts in almost everything you can think of as potential collaborators.”
‘Chimeric’ Idea Realized
Momentarily at a microphone for audience use, NIH director Dr. Francis Collins takes part in the scientific discussion, as he couldn’t resist what he called “this feast of wonderful science.”
Photos: Bill Branson
NIH deputy director for intramural research Dr. Michael Gottesman recalled it was nearly 2 years ago when NIH scientific directors “proposed the idea of a chimeric program that would allow investigators to come to NIH for several years and then have the opportunity to participate in extramural grant support, the goal being to give them about 12 years of protected research time.”
NIH-Lasker clinical scholars will spend the first 5 to 7 years as independent investigators in the NIH Intramural Research Program. In the second phase, an additional 5 years of funding will be offered to scholars who successfully complete the first phase. Investigators can stay here for phase 2, or take their funding with them to another research institution.
Opening the symposium, Lasker Foundation president Dr. Maria Freire described clinical research as an “exquisite interplay” involving bench scientists, clinical practitioners and “highly trained, highly skilled individuals who know the language of the laboratory, who are fluent in the language of patient care and who can move and communicate with ease in both worlds.”
NIH-Lasker clinical scholars will be those individuals, she said.
A Diaspora Delivers
Endorsing the new program, NCI director Dr. Harold Varmus said he represents “the old guard who came to NIH long ago as Yellow Berets,” almost all of whom opposed the Vietnam War and were interested in developing careers in academic medicine.
Collins noted a remarkable statistic: Varmus and fellow “old guardians” who participated in NIH’s Clinical Associate Training Program from 1955 to 1973 include nine Nobel prize winners—one every 2 years on average.
As Varmus and his colleagues departed the campus, many of them became what Varmus called “the Diaspora from NIH, creating strong departments in clinical and basic research around the country.”
He too cited reasons the rolls of clinical investigators have declined.
| NCI director Dr. Harold Varmus discusses his earliest days at NIH as a clinical associate.
| NIH deputy director for intramural research Dr. Michael Gottesman
|Lasker Foundation president Dr. Maria Freire talks about the new clinical scholars program
“There are lots of pressures on the system, despite the great opportunities,” he said. “Rising costs of research, declining numbers of patients in the CC and other important barriers to recruitment of clinical scientists to NIH—especially at the mid and high levels of accomplishment because of other financial opportunities and opportunities to work productively in the development of therapeutics in a way that can be difficult at NIH, if complete engagement with the industrial sector is advisable…NIH similarly is somewhat shackled by limitations in salaries and by ethics rules that can be overbearing.”
The new program may help ease some of these stresses, he said.
“This is a fantastic time for NIH to make full use of the potential of clinical research on this campus,” he concluded, “and there’s no better way to do this than to link with the Lasker legacy.”
|At the kickoff symposium for the collaboration are (from l) Lasker Foundation Chair Emeritus James Fordyce, Sawyers, Seidman, Freire, Kastner, Varmus, Collins, Gottesman, Linehan and Lasker Foundation chair Dr. Alfred Sommer.
Worthy Role Models
Introducing the symposium, Gottesman said the agenda featured “outstanding translational researchers who are role models for the kinds of scientists we would like to nurture in this program.”
In addition to Linehan, presenters included:
- Dr. Charles Sawyers of Memorial Sloan-Kettering Cancer Center, who discussed drug resistance in cancer treatment, particularly single-agent targeted molecular therapies;
- NHGRI scientific director Dr. Daniel Kastner, who came to NIH as a rheumatology fellow in 1985, and has spent more than 20 years studying genetic inflammatory diseases; and
- Dr. Christine Seidman of Harvard Medical School, who quipped that her talk would finally “get to the heart of things,” and spoke about cardiovascular disease and genetics.