'Endangered Species†or Just Getting Started? Life of the Clinical Investigator in Changing Times

For Peter Libby, MD, chief of cardiology at Brigham & Women's Hospital in Boston and professor of medicine at Harvard Medical School, the rewards of a life in clinical research outweigh the risks.

To make his case, Dr Libby started with an ominous headline: “THE CLINICAL INVESTIGATOR AS AN ENDANGERED SPECIES.” He flashed the headline on the screen and asked his fellow academic physicians to guess the era of origin.

Turns out it appeared on October 10, 1980—the work of a long-gone director from the National Institutes of Health (NIH)—penned before some of today’s youngest cardiologists were even born. Dr Libby’s point, made during an enlightening session on the “Impact of the Evolving Healthcare Landscape on the Academic Mission,” was that for all unrest over cuts to NIH funding, which he said is real and quite painful, such things are cyclical. With creativity, partnerships, and a focus on what’s positive about the world of research—and there’s much to be positive about—Dr Libby said the life of a clinical investigator can be better than ever, at least from a scientific perspective.

Dr Libby was among the presenters who focused on academic cardiovascular research during the session, which came near the conclusion of the 63rd Scientific Sessions of the American College of Cardiology in Washington, DC.

He acknowledged that there are real concerns about the viability of a long-term career in research. After a period of increased NIH funding during the Clinton administration, research funding has slowed, from a peak of $27.1 billion in FY 2002 (excluding 2 supplements in FY 2009-2010) to $22 billion today. Fallout from sequestration remains, and the uncertainty of how healthcare reform will affect clinical trials is a factor as well, as new payment models and creations such as accountable care organizations (ACOs) come into being.

But then Dr Libby displayed long-term funding trends, charting NIH funding, publications, the number of US doctorates, and US Food and Drug Administration (FDA) approvals since the 1950s, and while there were certainly ebbs and flows—and spikes in FDA activity—the trend lines moved toward more, not less.

“Yes, it’s bad. Yes, we will all feel it,” Dr Libby said. “But if we look at it from a generational perspective, it really isn’t all that bad.”

What’s more, he said, “The scientific opportunities have never been greater,” as advances in genomics have whittled the turnaround times for results and make it possible to get more than ever out of every NIH dollar. “Prior to next-generation sequencing, our doubling time was 19 months,” he said. “Now, our doubling time is 5 months.” Dr Libby predicted that the scientific possibilities will keep things moving even if other roadblocks emerge.

A career in research, which involves the eternal hunt for funding to advance projects, has always been risky, Dr Libby added. “All the alternatives are risky, too. Are you secure in the kind of compensation you have always secured under the Affordable Care Act, or under ACOs?”

To stay viable in the research realm, Dr Libby had some advice:

• Build networks, whether through professional societies or elsewhere.
• Join study sections, because being involved in the peer review process will help one understand the grant-writing process.
• Find good mentors, and for those who are at a different stage, be a good mentor.
• Going back and forth between research and clinical practice is viable and rewarding.

For all the funding hurdles and uncertainty, Dr Libby said a life in research offers rewards that few other professions can match. “How many people have jobs with the thrill of the chase?” he asked. In his view, the opportunity to spend each day in the “life of the mind” is well worth a little uncertainty.