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William Wood
As a junior faculty member at an academic medical center, I am in a position familiar to many others like me — building a practice and developing clinical expertise while pursuing a research agenda with hopes of eventually obtaining independent funding.
I practice primarily in clinical stem cell transplantation, with a small focus on non-transplant malignant hematology. From an academic standpoint, I’m very interested in outcomes research, both in terms of secondary analyses of registry or clinical trial datasets and primary studies investigating patient-reported outcomes.
Regarding the latter, I’ve worked during the past year or two to develop a project that looks at understanding and predicting transplantation-related toxicity from a patient perspective. I’m using pre-transplant physiological assessments and frequent, longitudinal post-transplant patient-reported outcomes (symptom burden and health-related quality of life) to create predictive models that I hope to eventually test and validate in larger studies.
I hope the results of these efforts eventually will inform projects that help to make transplantation — including outpatient protocols — safer and more available to patients who need it. Perhaps these studies also might inform other non-transplant areas of clinical oncology that might benefit from this relatively new technique of longitudinal patient-reported toxicity monitoring.
Despite my ambitions, I am well aware — as are others in my position — that my success will depend heavily on my ability to secure funding for this work. To date, my institution has been extremely helpful. I’ve had some excellent mentors in my area of interest and have been funded through an institutional KL2 that “protects” my research time and facilitates my career development.
The fight for funds
Moving forward from this grant, and as I need additional resources to support larger projects, I’ll be competing for a narrowing slice of NIH investigator funds. I’ve seen my peers who are a few years ahead of me struggle at this stage. Some have been successful upon grant resubmission. Others, after trying and missing, have considered other career trajectories, and a few have given up independent research ambitions altogether.
With this in mind, I recently flew to Washington, D.C., to participate in the American Society of Hematology Advocacy Leadership Institute. I had been nominated for this during the summer. I joined 26 other participants to learn about national issues affecting hematologists, as well as ASH’s role in influencing the legislative process. I admit I didn’t fully understand what I was getting myself into, but by the time I was done, I was extremely grateful for the experience.
As with all of ASH’s activities, this institute was focused, educational and productive. After reading a well-prepared briefing book with a refresher on Civics 101 and the current era of jeopardized NIH funding, I spent a day listening to ASH leadership, legislative assistants, a former congressman, the deputy director of the NHLBI and others. I gained immediate and effective insight into the legislative agenda in Washington and the looming danger of budget sequestration.
The next day, I traveled with co-participants and Patrick C. Irelan, ASH’s policy and practice coordinator, to Capitol Hill for a series of meetings with senators, members of Congress and legislative staffers. I felt I was more than adequately prepared to make my case for the importance of protecting NIH funding, and as I reflected on my own and others’ experiences at our home academic institutions, I became increasingly passionate about this.
A lot may change between now and January. Congress will meet again, and many are working overtime to avert budget sequestration.
I am optimistic that we will be able to avoid this. The effects of sequestration, however, would be absolutely draconian. NIH funding has not increased in real terms for years, and the prospect of an 8% budget sequester cutting $2.5 billion in NIH funding is almost unfathomable. If this were to happen, my own response — and I am sure that of others like me — would be to buckle down and just “try harder” to achieve NIH funds.
Whether the funding line is 19%, 9% or 1.9%, those of us who are passionate about our dreams and who must rely on NIH funding won’t give up until we have no other choice. But the possibility of coming to a crossroads one day in the future when there truly might be no other choice is unsettling and distressing.
The search for an ally
Before the ASH Advocacy Leadership Institute, I felt that most of the external circumstances affecting bigger picture issues — whether related to oncology drug shortages, NIH funding or otherwise — were completely beyond my control. Now, though, I have confidence that I have an ally in ASH, and with the help of ASH and others, I have the ability to access my elected officials, make my voice heard and try to shift the discussion in favor of junior faculty like me.
As importantly, I have a better feel for the type of organization that ASH really is. I wasn’t asked by ASH to write this column, but — for those of you reading this who are in a similar career stage as I am — I can’t say enough good things about what ASH represents and the myriad ways to get involved.
ASH is much more than the annual meeting that most of us immediately associate with the organization. I suppose I already knew this through my own past participation in the ASH Clinical Research Training Institute, an incredible experience in its own right that could serve as a subject in a future column, but I don’t think I previously appreciated the extent of other opportunities available through ASH.
There are ways to participate in scientific or other standing committees, develop new educational programs, contribute to the “consult a colleague” initiative, volunteer to help overseas, act as a health policy advocate, and this list goes on. Above all, I have come to appreciate that those who are involved in these efforts are doing so for the right reasons. They are devoted to improving the practice of hematology and, above all, creating an environment that will translate into improved health outcomes for patients.
During the next several years, as I continue to grow my practice and work toward independent funding, I am sure that I’ll also be spending a portion of my professional time on ASH-related activities. I would encourage others to do the same.
For more information:
William Wood, MD, is an assistant professor of medicine in the division of hematology/oncology at the University of North Carolina in Chapel Hill. He may be reached at UNC Health Care System, Division of Hematology and Oncology, 101 Manning Drive, Chapel Hill, NC 27514; email: william_wood@med.unc.edu. You also may follow him on Twitter (@WoodBD).
Disclosure: Wood reports no relevant financial disclosures.