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August 1999
Volume 63 |
Number 8
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FAER REPORT
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| FAER Stresses
Need for Increased Clinical Research Proposals |
The Foundation for Anesthesia Education and Research's (FAER)
contribution to improving the specialty focuses on training exceptional
investigators. FAER supports both basic and clinical researchers
but most recently stresses the need for increased clinical research
proposals.
The authors of "The Changing Landscape for Clinical Research"
discuss the development, current state, challenges and opportunities
of clinical research in the United States (Academic Medicine,
Vol. 74, No. 6/June 1999). The article provides a valuable context
for recognizing the growing importance of the resources anesthesiology
invests in clinical research through the American Society of Anesthesiologists,
FAER, the Anesthesia Patient Safety Foundation and the Wood Library-Museum
of Anesthesiology.
The introduction of "experimental science into the teaching
and practice of medicine" and the system of full-time faculty
appointments in research occurred near the end of the 19th century.
Initially, funding was provided almost entirely by outside, nongovernmental
sources. After World War II, the federal government became a significant
contributor primarily through the National Institutes of Health
(NIH). Medicare and revenues from clinical practice of faculty
physicians also provided funding for the newly formed academic
medical centers. With strong funding from these sources, academic
medical centers were propelled into leading positions in producing
biomedical research, advances in medicine, and in training basic
and clinical biomedical investigators.
Over the years, a significant growth as well as a change
in the sponsors of national health research and development evolved.
Industry, primarily pharmaceutical companies, surpassed the federal
government, primarily NIH, as the largest supporter of health
research and development. In 1987, industry supported 42 percent
of the $17 billion expenditure. In 1996, industry's share had
grown to 52 percent of the $36 billion spent. The largest expenditure
for pharmaceutical research is clinical trials. Academic health
centers are recipients of approximately one third of these funds,
a total of $12 billion in 1997. The majority of NIH funding awarded
to medical schools was to the same 10 specialties, half were clinical,
but interestingly, anesthesiology was never in this group.
Recent changes in funding have presented challenges to
the long-term stability of clinical research. Managed care forces
lower revenues from negotiated prices and diverts patients from
academic medical centers to lower cost providers. It also limits
access to clinical specialists who may be engaged in clinical
research. The authors cite data indicating medical schools in
areas of high managed care have experienced decreased rates of
growth in NIH funding. The commercialization of clinical trials
has forced academic centers to discount their service fees and
has intruded upon the relationship between sponsors and investigators.
The Balanced Budget Act of 1997 mandates changes in Medicare payments
to teaching hospitals. The net of these changes will be a large
reduction in payments to teaching hospitals for costs related
to research and education. Investigators have been drawn away
from research into clinical practice as organizations minimize
costs and increase productivity in clinical practice.
Another significant phenomenon is the decline in clinical
research conducted by physician investigators. The percentage
of NIH research projects awarded to physician scientists has dropped
over the past 30 years. The number of first-time physician applicants
has declined over the past three years, and if not funded initially,
they are less likely to modify and resubmit their applications.
These trends lead to a real concern that physician-led clinical
investigation is severely threatened. The ASA Committee on Research
expressed similar concerns, which led to modification of the grant
process for FAER awards in an effort to address this problem within
the anesthesiology community. More clinical research programs
are offered, and the deadline dates have been changed to encourage
modification and resubmission of new proposals.
The practice of clinical research stands at the threshold
of an era of unprecedented scientific and technologic opportunity.
The potential for translating and integrating basic findings into
new medical treatments and procedures is great. To realize these
opportunities, the anesthesiology research community will need
to not only invest heavily in research activities, but also in
the development of clinical investigators. Anesthesiology must
increase the number of physicians opting for investigative careers,
increase mentoring, provide time, funds and opportunity to conduct
clinical research. It is only through clinical researchers that
the opportunities for advancement in scientific and patient care
will be fully realized.
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