ORS president wonders ‘Whither goes the ORS?’
By Mary Ann Porucznik
In his presidential address yesterday, Orthopaedic Research Society (ORS) President Joshua J. Jacobs, MD, outlined a potential new course for the ORS, focused on a growing trend in healthcare research—translating and applying knowledge gained in basic research to the clinical setting.
As he pointed out, Congressional appropriations for the National Institutes of Health (NIH) basically doubled between fiscal year (FY) 1998 and FY 2003, increasing from $13.7 billion to $27.1 billion. However, since then, appropriations have been flat or have even decreased because of the inflationary pressures on biomedical research costs.
As funds increased, so did the percentage of applicants who successfully competed for research project grants. But with more grant applications, the percentage of applicants actually funded has “precipitously declined” in recent years.
“In the wake of the doubling of the NIH budget, our policy makers are asking, What is the return on our investment in research?...I will take the high road and suggest that Congress may actually be on the right track, holding us accountable to the U.S. taxpayer, whose largess supports the activities of our institutions and laboratories,” said Dr. Jacobs.
“The public and policy makers expect that the investment in biomedical research will improve health status and quality of life,” he continued. “We are being asked how the public’s investment in research is being translated into improving public health.”
This call for accountability and translational research presents both challenges and opportunities, ranging from escalating health care costs and disparities in treatment outcomes to a rapidly evolving scientific landscape that enables the development of advanced technologies and encourages increased collaboration with physical and quantitative disciplines.
The NIH roadmap
Dr. Jacobs reviewed the NIH roadmap to realize a vision of translating research findings into improvements in public health and quality of life. The roadmap, which has three major elements, provides investment for emerging and needed areas of research such as biologic pathways and networks, supports individual creativity and collaborative team efforts through interdisciplinary research and public-private partnership, and assists clinical research by harmonizing regulatory policies, and supporting multidisciplinary training, development of new networking and diagnostic tools and establishment of academic homes for clinical and translational research.
“One manifestation of the roadmap is the development of new grant mechanisms at the NIH,” noted Dr. Jacobs. “The Clinical and Translational Science Award is intended to ‘provide integrated intellectual and physical resources for the conduct of original clinical and translational science…These environments will enhance the theoretical underpinnings of the discipline, provide much needed educational programs, contribute to the growth of well-structured and well-recognized career pathways, and provide a research environment that is more…conducive to, and responsive to the demands of modern translational and clinical research.’”
Dr. Jacobs also pointed to the Centers of Research Translation (CORT) Award, another novel grant mechanism, unique to the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS). “This mechanism emphasizes disease-specific research translation with a scientific advisory group to include interested lay members and industry representatives. It calls for a minimum of three disease-linked projects, at least one of which is clinical and one of which is basic. The scientific advisory group provides oversight of any supplemental pilot projects,” said Dr. Jacobs.
Because the CORT concept embraces both the translation of new scientific information to clinical application, and the application of clinical findings to new research, Dr. Jacobs called on the orthopaedic research community to respond, “so that our science and our scientists can access these resources and keep pace with translational research in other disciplines.”
Although “the definition of translational research is in the eye of the beholder,” according to Dr. Jacobs, “the most useful definition is one that is broad, inclusive and not proscriptive.” After comparing several definitions from various Web sites, Dr. Jacobs suggested his own definition: “Translational research is research that brings discovery directly from the bench to practical applications in patients.”
The role of the ORS
Dr. Jacobs then proposed an ORS translational roadmap, organized around five themes: the formation of interdisciplinary teams, a focus on specific musculoskeletal diseases, cross-disciplinary education, translational career pathways, and a “translational interface.”
“In my view, the ORS is uniquely suited to be a catalyst for research translation. By its very structure, the ORS has emphasized the interdisciplinary nature of orthopaedic research. The codified organization around the three constituencies of the clinician, biologist, and engineer ensures that each research community will be well represented in the Society’s activities and programs. This ‘triumvirate’ serves to promote unity of purpose and serves as a platform for assembly into interdisciplinary teams that include the life sciences, the physical and quantitative sciences, and the translational sciences,” he said.
He also recognized the critical role that industrial scientists play in translating research. “In many ways, industry scientists are agents of translation—their professional activity involves the practical applications of the scientific advances in our field,” said Dr. Jacobs. “Our industry scientists are an underused resource that we hope to tap through new initiatives, such as the establishment of our Corporate Affairs Committee.”
Pointing to the historically strong focus on musculoskeletal disease, Dr. Jacobs called for “the establishment of disease-specific clusters or special interests groups organized around the refractory chronic musculoskeletal diseases that plague our society including osteoarthritis, osteoporosis, intervertebral disc degeneration, degenerative tendonopathy and periprosthetic osteolysis.
“Organization of at least a portion of our society’s activities around specific diseases provides a natural framework for research translation, breaking down traditional academic silos while further integrating our members around disease themes, rather than traditional academic disciplines,” he said.
Dr. Jacobs also called on the ORS to play a major role in developing the basic science language of the clinician, as well as in educating nonclinical scientists in the language of the clinician. He also proposed that the ORS develop specific career development programs for the emerging translational researcher.
“These programs should be developed in partnership with clinical professional societies and designed to provide the young investigator with tools that they need to become independent scientists. Education in clinical trial design, biostatistics, epidemiology and clinical research regulation will likely be key components of these programs. Mentorship will also be a critical component this initiative,” he said.
A unique position
Dr. Jacobs outlined the unique position and activities that would enable the ORS to serve as the interface for research translation, including the ORS annual meeting, the further integration of the ORS and AAOS meetings, and the society’s Journal of Orthopaedic Research, which he said could be “an important vehicle for the promotion of the best translational and clinical science.
“In summary,” he concluded, “the ORS is an organization that is uniquely poised to help its members respond to the demands for research translation. The roadmap I have outlined around these five themes is intended to make our organization even more relevant in our professional lives. This roadmap is intended to transform the ORS into an organization that is a true catalyst for improving the musculoskeletal health of the public. Let us all work together to build on the successes of the past.”