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Supporting early career scientists aims to avert lost generation of lupus researchers
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With the need for rheumatologists expected to outpace national demand by 2030, the necessity to get more physicians into the field becomes more pronounced with each passing year. Behind the scenes, however, there remains an urgent need for additional clinician-scientists to drive research — particularly in areas like lupus, a condition which has received a disproportionate share of therapeutic setbacks and disappointing clinical trials in recent years.
To forestall a potential shortage of clinician-scientists and reinvigorate interest in academic careers for lupus research, in 2013, the Lupus Foundation of America created the Gary S. Gilkeson Career Development Award (CDA). Intended to foster the professional development of second- or third-year fellows in rheumatology, nephrology and dermatology who are interested in becoming independent clinician-scientists, the award provides two recipients with up to $70,000 in funds to be used as a springboard toward a career at an academic, medical or research institution.
The two recipients of the CDA for 2018 were Joyce Chang, MD, an attending physician in the division of rheumatology at Children’s Hospital of Philadelphia, and Paul Hoover, MD, a newly appointed instructor in medicine and rheumatology at Brigham and Women’s Hospital in Boston.
Healio Rheumatology spoke to Karen H. Costenbader, MD, MPH, chair of the Medical-Scientific Advisory Council of the Lupus Foundation of America and director of the Lupus Program at Brigham and Women’s Hospital in Boston, about the current shortage of lupus researchers, the impact of such shortages on outcomes, and how this award may help.
Q: Why is there a shortage of lupus researchers?
Costenbader: Although it is not quite clear, there are probably multiple factors leading to the shortage of lupus investigators. Lupus has to compete with many other biomedical fields and diseases to attract the best and the brightest young physicians and scientists to its study. There are many more young investigators who are, unfortunately, never enticed to study lupus.
A 2014 study fielded by the American College of Rheumatology with approximately 400 respondents showed that rheumatologists also cited a lack of mentorship as the primary reason young investigators leave lupus research. The lack of mentorship may relate to overall lack of funding for lupus research compared to other fields, such as cancer and cardiovascular disease.
Q: Why is the lack of funding an issue for lupus research?
Costenbader: While not really that rare, lupus is an enigmatic disease and, in general, there is a lack of awareness about what it is, how serious it is and even how fatal it can be. In many hospitals and institutions, rheumatology is a small subspecialty of medicine; thus, there are not enough dedicated funds and investment in subspecialty areas like rheumatology, and lupus is just one of many serious rheumatic diseases. This leads to a dearth of lupus physicians and investigators, and a lack of mentors for the next generation of lupus physicians and investigators on whom we are counting to make the big breakthroughs in this extremely complex autoimmune disease.
Q: How does this shortage of scientists/funding impact care?
Costenbader: Biomedical and clinical research lead directly to advances in clinical care and improvements in health outcomes on a daily basis. We have to keep up the pace of discoveries about the basic mechanisms of disease, identification of new drugs and targets and their thorough testing in clinical trials, and study of the epidemiology, clinical care delivery and outcomes in lupus. If we don’t support scientists in these lupus research fields, we won’t have the knowledge, studies and advances needed to care for individuals living with this complex disease.
Q: What are some of the common barriers for rheumatologists in an academic research career?
Costenbader: There are many challenges and barriers to conducting academic research as a rheumatologist, in particular for starting out in research, but actually throughout one’s career. Grant funding is tight and very competitive, and, as I mentioned before, rarely lupus-dedicated. Long years of medical and post-graduate training are required to even get to the stage to be able to write and submit a grant application.
Rheumatology is one of the lowest paid of all medical subspecialties, so it really is difficult for young physician investigators with debts from medical school and young families, to hang in there without funding and protected time. The lack of good mentorship, guidance and support are huge barriers to entry into the field as junior lupus investigators seek to develop in their research studies and ideas, and look toward future opportunities and studies.
Q: How does the CDA assist in helping researchers establish themselves in this field?
Costenbader: The Lupus Foundation of America Gary S. Gilkeson Career Development Award is one of a kind. There are no other young investigator-specific awards for research in lupus. It provides a fantastic incentive to enter and stay in lupus academic research, by ensuring that the awardee is well-supported financially at this critical start-up time, and by providing the mentorship of an established lupus researcher with in-depth experience with lupus research.
The benefits of the CDA enable talented young researchers to remain in the field and continue innovative advancements in lupus research. These young investigators have already made substantial contributions to our knowledge of lupus and its care and outcomes. This is very encouraging, and we look forward to their future discoveries.
Q: Could you discuss some of the history of the award?
Costenbader: In 2013, the Lupus Foundation of America established the Gary S. Gilkeson CDA to facilitate professional growth for fellows focused on lupus research. The idea for the award was developed with consultation from then Medical-Scientific Advisor Council (MSAC) chair Gary Gilkeson, MD, and other members of the MSAC, identifying what would be the most helpful way to support early career scientists. This was also in response to the fact that other “young investigator” awards are not lupus-specific and allow investigators to have already received significant NIH funds. This award uniquely prepares a scientist at the very beginning of their research career. In 2017, the award was renamed the Gary S. Gilkeson, MD Career Development Award in his honor when he stepped down as the MSAC Chair of the Lupus Foundation of America after 13 years in that position.
Q: What new avenues of research does this award permit for early career scientists?
Costenbader: We have had outstanding applications from junior investigators in basic immunology, translational research, identification of biomarkers, and improvement of clinical care. Some of the funded CDAs included studies of the risk of infection among lupus patients with the use of different immunosuppressants, identification of risk factors for heart disease in children with lupus, causes of mental health conditions in childhood lupus, risk factors for fractures among lupus patients and characterization of networks of immune cells critically involved in lupus nephritis.
Q: How might this award improve lupus research in the future?
Costenbader: The CDA provides funding for many critical areas of lupus research and continues to make important contributions to the understanding of lupus and its sequelae. All six past awardees have continued their lupus research and received or applied for funding from the NIH. In a very measurable way these junior investigators have already had an effect on the field of lupus research and contributed to improvements in clinical care.
I think this award is going to have a large and lasting impact. I am very hopeful that the new knowledge contributed by this crop of new investigators will significantly improve the lives of lupus patients. I also hope — and believe it is already happening — that this group of young investigators will themselves become excellent lupus research mentors for those coming up behind them, encouraging more of the very promising young investigators to use their skills to attack this disease. – by Rob Volansky
For more information:
Karen H. Costenbader, MD, MPH, can be reached at 75 Francis Street, Boston, MA 02115; email: kcostenbader@bwh.harvard.edu.
Disclosure: Costenbader reports research funding from AstraZeneca, GlaxoSmithKline, the Lupus Foundation of America, Merck and the National Institutes of Health.