One of the most successful research enterprises funded by the NIH, the Clinical Research Center (CRC) program, is dying, its highly productive life cut short with virtually no discussion in the scientific community. As longtime CRC users and the director (David M. Nathan) of one of them for more than 25 years, we mourn their loss even as we question the decision to abandon them.
American hospitals and medical schools once carried out little or no clinical research. In 1910, Rockefeller University in New York built basic research labs around a suite of 20 or so hospital beds. Think of this as what is today called translational research — using patient care to inform research and research to improve patient care. Massachusetts General Hospital in Boston did something similar a few years later.
The NIH opened its flagship 200-bed CRC in 1953. Others were later established at major teaching hospitals around the country. At the program’s peak, the NIH was funding almost 90 CRCs.
Over the years, CRCs have provided human laboratories where diseases are studied and new treatments developed and tested. The CRCs include not only specialized inpatient beds and outpatient facilities, but a highly skilled group of research nurses, dietitians, research coordinators, technicians, and physicians who study patients with complex disorders in a research setting.
These unique collaborative spaces have had an important impact on modern medicine. A small sampling of the output from the two original CRCs (Rockefeller and Massachusetts General) includes the development of combination chemotherapy for HIV; the treatment of heroin addiction with methadone; revolutionary advances in the intensive treatment of type 1 diabetes; and major breakthroughs in the treatment of disorders of growth and development.
The decision to cut off funding for the CRCs comes as a surprise. None of the five recent outside reviews of NIH external programs ever suggested defunding the CRCs. Yet as we write in Monday’s Journal of Clinical Investigation, the NIH leadership has ruled that funding the space and staff of the CRCs will no longer be permitted.
This defunding is likely to lead to “repurposing” of the beds for general use and abandonment of this vital resource for clinical research. The loss of the trained clinical nurses will be particularly damaging.
The study of patients by academic physicians who intimately understand disease processes has long been under assault. Physician scientists, particularly those who focus on clinical research, have been marginalized in grant competitions for decades. The NIH’s unjustified decision to defund the CRCs further imperils their work.
The CRCs have been “homes” for physician scientists who wish to work with living patients and find new diagnostic methods and treatments that will help them. The future of personalized medicine will require more, not less, careful patient study. We disagree with this poorly considered decision to let the CRCs drift away. That would be a particularly painful loss for the medical community.
David M. Nathan, MD, is director of the General Clinical Research Center of the Diabetes Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School. David G. Nathan, MD, is president emeritus of Dana-Farber Cancer Institute, physician-in-chief emeritus at Boston Children’s Hospital, and professor of pediatrics at Harvard Medical School.