Potholes ahead on the road to scientific discovery could make you sick

When the National Institutes of Health (NIH) recently celebrated the 50th anniversary of the Medical Scientist Training Program in Bethesda, Md., I was there, listening to other graduates of this M.D.-Ph.D. training program describe the work that they had done since graduation. 

One spoke about how he and his students had tracked down a single change in the human genome responsible for a rare congenital disease, and then identified the underperforming protein that resulted.  They were now busy using this information to test therapies that could prevent children born with this disease from dying in infancy. 

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Another graduate described how a gene rearrangement found in patients with a particular type of gastric lymphoma led to this cancer—and how a parallel pathway seemed to account for many other types of cancers.  Her story developed over many years of work as a physician-scientist, during which she treated children with cancer, led a research team, and taught students and post-doctoral fellows how to look at a patient’s disease with the eyes of a scientist. 

Another speaker, still not done with his M.D.-Ph.D. training, explained how he was adapting schemes used by economists to understand the benefits and risks associated with a new medical procedure or treatment.

I was tremendously inspired.  And there were many more stories that could be told, as the physician-scientists who graduated from this NIH program—and many others who carry out patient-oriented research no matter what degrees follow their name—have made countless discoveries that impact each of our lives.  Antibiotics and vaccines allow us to survive childhood infections; medications allow those of us with diabetes or risk factors for early death from heart disease or stroke to live to a healthy old age, and many cancers that used to be rapidly fatal can now be cured or controlled for a long time.

But these great stories can’t be told without serious investment.  Graduating from a M.D.-Ph.D. program is only the first step in a long journey that continues to require hard work and sacrifice from a young physician-scientist.  The average M.D.-Ph.D. graduate is 31 years old.  She or he still needs to complete three to six additional years of clinical training to become a pediatrician, or a surgeon or a cardiologist, and then must return to the laboratory for another three to five years of postdoctoral training.

The work of these physician-scientists “in-training” means that all of us have access to the newest findings, medications and treatments when they care for us at teaching hospitals across the country.  The discoveries they make during their long apprenticeships in hospital and university laboratories increase our knowledge of disease, even as they prepare them to be the leaders and teachers for a next generation of students.

All of this training costs money.  Universities, the NIH and philanthropy offset the costs of medical and graduate school, so student debt won’t drive these graduates toward careers in private practice.  Medicare provides hospitals with funds that offset some of the costs of training M.D. graduates during their medical or surgical residencies.  The postdoctoral years of training in the laboratory are often funded by stipends from the NIH or private foundations, albeit at salaries far below those enjoyed by a doctor in private practice.  And government dollars again pay for most of the clinical and laboratory research carried out by physician-scientist faculty in our universities, medical schools and hospitals. 

Most economists and policy makers agree that this is a great investment.  Biomedical discoveries are drivers of our economy:  They keep us healthy and productive, create new technologies and treatments, and lead to jobs for the workers who make and use these products that improve our health.

But the infrastructure that supports the training of physician-scientists is crumbling, much like our bridges and roads.  More physicians are needed to take care of our aging population, but the number of positions for residents-in-training hasn’t grown since 1996—an increase would require congressional approval of more Medicare spending. 

The budget of the NIH, in inflation-adjusted dollars, has decreased to levels last seen in the previous century, as discretionary spending is cut, sequestered and capped.  Fewer dollars support fewer scientists and less research.  Physician-scientists, on average 45 years old when they receive their first “major” research grant (an R01), are dropping out in favor of careers that will support them and their families:  clinical practice, teaching, work in a pharmaceutical company.  Lost is the immense satisfaction of discovering the cause of a disease, a better diagnosis, a new treatment. Too often, research is abandoned when there is simply no one willing or able to support it.

So it is a bittersweet moment at the NIH and across the country. There is an amazingly capable and motivated group of physician researchers in the U.S., able to take care of us with the best treatments available while working to discover new remedies for diseases we don’t yet understand.  But this crucial pipeline--from M.D.-Ph.D. graduate to resident to research fellow to faculty--is leaking as badly as the aged water mains that burst and flood our city centers.  Both need investment, and both are equally vital for our public health. 

So the next time that you or a loved one takes a medication, or sees the doctor for a yearly physical—or has a life-saving treatment in the hospital—don’t take it for granted.  Write to your Congressional representative to ask for action on a bill that would support training an additional 15,000 residents over the next five years, so graduating medical students can become capable physicians that will care for you and your family.  As The New York Times recently noted in an editorial, partisan gridlock and competition for resources have stalled efforts to alleviate a doctor shortage.

Let your representatives know that support for biomedical research—and for the scientific teams that make these remarkable discoveries—needs to be restored and to grow.  Otherwise, the increasingly bumpy road that all of us physician-scientists travel will soon become impassable, and the sorts of medical advances that have transformed our lives will become increasingly rare.

Kazmierczak, M.D., Ph.D., is director of the Yale University School of Medicine’s M.D./Ph.D. Program and an associate professor of Infectious Diseases and Microbial Pathogenesis; she is a Public Voices Fellow of The OpEd Project.