Budget cuts and the importance of continued innovation

Issue: July 2013

ByRobert Gerszten, MD

ByJagmeet P. Singh, MD, PhD

ByPatrick T. Ellinor, MD, PhD

Challenging economic times have resulted in marked cutbacks at the NIH and the American Heart Association, the mainstays of support for CV investigators. In the past 5 years, the likelihood of getting a successful NIH grant has fallen from one in four to about one in 10. Sadly, this has resulted in even highly qualified investigators struggling to support their research laboratories. Funding reductions have led to the curtailing of research projects, reductions in staff and a slower pace of scientific advancement. Newly emerging investigators are particularly vulnerable in this fiscal climate.

Nontraditional sources of funding

To help address these funding challenges, leading institutions, clinics and research hospitals from around the country must look for nontraditional solutions to secure and distribute funding.

Robert Gerszten

Jagmeet P. Singh

Patrick T. Ellinor

One example is the establishment of SPARK Awards at the Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care. These awards, which are funded by a philanthropic gift to the institute, drive innovation through the direct funding of junior and mid-career physician scientists’ projects. Funding projects led by up-and-coming researchers can enable groundbreaking research with the potential to transform patient care and the health care industry overall. These awards can also serve as seed money for projects to get off the ground and receive national funding through organizations such as the NIH or AHA.

Whereas grant review panels are often conservative in nature and fund aspects of science that have already been explored, the SPARK Awards foster exploration among our peers to help deliver on a mission of developing the medicine of tomorrow.

An example of the success of such awards is the 2012 SPARK Award. The award was received by Patrick T. Ellinor, MD, PhD, who led a team of cardiologists and neurologists at the Institute of Heart, Vascular and Stroke Care with junior faculty member Steven A. Lubitz, MD, MPH, who drove the daily research, for “Translating Genetic Discoveries for Atrial Fibrillation into Clinical Risk Markers for Stroke.”

With this grant, the team was able to systematically explore genetic links between AF and stroke. The investigators discovered that AF-related genetic variants associate with stroke, even among individuals without known AF. These findings imply that genetic markers may actually help identify people who have AF as a cause of their stroke when no other cause has been identified. In other words, we may be able to find patients at risk for AF or patients who have AF that we may have missed. Such findings may have significant implications for treatment, since patients with stroke due to AF are typically treated with blood thinners, whereas others often are not.

Search for progress

Using the SPARK Awards as one example, Lubitz and other junior faculty members were able to receive resources at a vulnerable time as they are launching their careers. Such funding provided a critical bridge that enabled Lubitz to subsequently receive an AHA fellow to faculty grant and an NIH K23 Award for the extension of this type of work.

In order to move forward in this challenging environment, it is imperative that we work together to find funding for research that will advance the field of medicine and develop alliances within individual areas of research.

We must find new ways to generate funding, create collaborative cross-disciplinary alliances and align our priorities to deliver cutting-edge science. If we do not find strategies to work around budget cuts, innovation will suffer at a time when we are poised to reap the benefits of the genomics revolution. Further, the medical community as a whole will be less competitive in the international market.

Note: The goal of the Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care is to advance the diagnosis and treatment of heart, vascular and cerebrovascular conditions by providing comprehensive patient care while shaping the medicine of tomorrow. Under unified leadership from Mass General’s Corrigan Minehan Heart Center, the Vascular Center and the Stroke Service, the Institute is pioneering a new model that involves complete integration of clinical care and research across disciplines. This patient- and disease-focused model combines basic, translational, and clinical research with the expertise of a multi-specialty panel of expert scientists and clinicians. By bridging multiple disciplines, the leadership of the Mass General Institute for Heart, Vascular and Stroke Care is developing educational programs that reinforce the opportunities offered through integrated care, while also working to address critical issues of health policy and reform that will pave the way in quality patient care.

Robert Gerszten, MD, is director of clinical translational research; Jagmeet P. Singh, MD, PhD, is director of the resynchronization and advanced cardiac therapeutics program; and Patrick T. Ellinor, MD, PhD, is director of the cardiac step-down unit, all at the Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care.

Robert Gerszten, MD, can be reached at the Massachusetts General Hospital Gerszten Laboratory, CNY 149-8, 149 13th St., Charlestown, MA 02129; email: rgerszten@partners.org.

Jagmeet P. Singh, MD, PhD, can be reached at the Massachusetts General Hospital, Cardiac Arrhythmia Service, 55 Fruit St., Boston, MA 02114; email: jsingh@partners.org.

Patrick T. Ellinor, MD, PhD, can be reached at the Massachusetts General Hospital, Cardiac Arrhythmia Service and Cardiovascular Research Center, 55 Fruit St., Boston, MA 02114; email: pellinor@partners.org.

Disclosure: Gerszten, Singh and Ellinor are employees of Massachusetts General Hospital. They report no relevant financial disclosures.