The New Medicine

Seeking to make the most of new scientific opportunities in an era of rising research costs and shifting income sources, Harvard Medical School...

Seeking to make the most of new scientific opportunities in an era of rising research costs and shifting income sources, Harvard Medical School (HMS) and its affiliates are launching ambitious collaborations to investigate cancer and to expedite testing of new drugs.

In October, the newly formed Dana-Farber/Harvard Cancer Center applied to the National Cancer Institute to be designated a regional comprehensive cancer center. The collaborative, which would succeed and broaden the designation accorded to Dana-Farber Cancer Institute since 1973, envisions a multidisciplinary effort to understand the causes, prevention, and treatment of the disease.

Organized during the past two years by David G. Nathan, M.D., president of Dana-Farber and Smith professor of medicine, the new effort has created programs focusing on five types of cancer: breast, gynecologic, leukemia, lymphoma, and prostate. Each is designed to interact with 10 "discipline-based" programs of research: biostatistics, cell biology, genetics, immunology, viral oncology, epidemiology, risk reduction, outcomes research, imaging, and experimental therapeutics. These programs--and forthcoming efforts, including additional disease-specific programs (for brain, skin, AIDS-related, and other cancers) and discipline-related projects (in fields such as palliative care and nursing research)--already command significant resources. More than 800 faculty members at the member institutions have joined the new center; collectively, they conduct more than $235 million in cancer-related research each year, in nearly 500,000 square feet of facilities.

"All of the member institutions conduct incredible basic, clinical, and population-based research," says Nathan. The new center provides a way to "knit these resources together to share resources and coordinate our efforts in a more focused and efficient manner," in part by overcoming barriers separating researchers based at HMS, the School of Public Health--a full member of the center and an important resource, given its expertise in population-based and epidemiological research--and the hospitals. In part, the extended center also hopes to secure funds to operate the laboratories and equipment required to conduct current experiments. The center application seeks support for some of 18 "core facilities," many of them beyond the means of any one school or hospital. The "vector core," for example, develops viruses and other agents that can ferry desired genes into cells to correct cancer-causing genetic errors. Other shared facilities specialize in pathology and DNA sequencing.

Turning to purely applied science, the Harvard Clinical Research Initiative, approved by the Corporation last fall, is now recruiting a chief executive officer. A joint venture of HMS and its principal hospital affiliates, the initiative will operate a nonprofit corporation that will conduct drug trials for pharmaceutical companies on a contract basis. Organized over the past 18 months by Raphael Dolin, HMS dean for clinical programs and professor of medicine, the new entity aims to provide a single point of entry to HMS and affiliate expertise, and to assure clients of quality control in experiment design, better and faster assembly of patient populations, and superior data analysis.

In recent years, the need for clinical drug trials has expanded to match the volume of compounds emerging from laboratories. But questions have arisen about quality and conflicts of interest in the for-profit trial industry and in industry-academic contracts. Hence an opportunity, as Joseph B. Martin, HMS dean and Walker professor of neurobiology and clinical neuroscience, puts it in his 1999 annual report, "to provide efficient contracting to industry, trials with academic rigor, and a patient population large enough to find out quickly how effective a new therapy may be."

Accordingly, Dolin told the faculty last spring, many academic medical institutions are exploring ways to enter the market. A significant new stream of revenue is at stake: the HMS annual report suggests that the volume of industry-sponsored clinical contracts--now about $40 million annually across the community of Harvard and affiliates--is expected to grow to $140 million during the next five years. That could make a significant contribution toward defraying the overhead costs of other research.

More broadly, these two initiatives, begun since Martin became dean in mid 1997, bring to reality the theme he has sounded repeatedly: "the necessity for collaboration and interdisciplinary endeavors." Indeed, his annual report observes, "In research, opportunities for major advancement through collaboration are so compelling that our highest hurdles are not the scientific unknowns of a generation ago, but rather finding the time, space, and resources necessary to move the collaborations forward." Genomic research, he writes, has "produced new approaches to research that are every bit as important as the genome map itself," enabling scientists to "devise myriad new approaches to discovering how our bodies' nucleotides, genes, and proteins interact and function to enable health and to create disease." medical school building

These new research opportunities, Martin continues, "were not developed by a single traditional discipline, and they will not move forward at an optimum pace unless they are embraced by multidisciplinary teams." In that sense, beyond their scientific potential, the cancer center and the clinical-trials venture are large, high -profile efforts to rethink how biomedical research must be organized and paid for in the twenty-first century. They usher in an era when the scientist alone at her bench may be as much an anachronism as the family physician in solo practice.

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