AAOS Bulletin - December, 2005

AAOS, NIH discuss research, cooperation

By Gunnar B.J. Andersson, MD; Christopher Evans, PhD; and Joshua J. Jacobs, MD

Members of the AAOS Council on Research and Scientific Affairs, Research Committee and the Orthopaedic Research Society (ORS) met with prominent leaders from the National Institutes of Health (NIH) in October to discuss research agendas, funding and cooperative opportunities. The meetings emphasized the burden of disease associated with musculoskeletal disorders as well as the need for increased funding for clinical and basic musculoskeletal research.

The AAOS/ORS delegation included Joshua J. Jacobs, MD, chair of the Council on Research and Scientific Affairs and ORS president-elect; Gunnar B.J. Andersson, MD, PhD, Research Committee chair; Christopher Evans, PhD, ORS president and a member of the Research Committee; and Laura L. Tosi, MD, AAOS liaison to the National Osteoporosis Foundation. We were accompanied by AAOS chief executive officer Karen L. Hackett, FACHE, CAE; Robert H. Haralson III, MD, executive director, medical affairs; Brenda Welborn, ORS executive director; David Lovett, JD, director of the AAOS Washington, D.C., office; and Christy M.P. Gilmour, manager, medical research, AAOS department of research and scientific affairs.

From NIAMS to NIH

During the regular AAOS Research Committee meeting with Stephen I. Katz, MD, PhD, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) this year, Dr. Katz suggested that we consider establishing contacts with NIH Director Elias A. Zerhouni, MD, and other NIH institutes.

(From left) Representatives from the AAOS and ORS—Gunnar B.J. Andersson, MD, PhD; Joshua J. Jacobs, MD; and Robert H. Haralson III, MD—met with NIAMS director Stephen I. Katz, MD, PhD, and other representatives from the NIH in October.

Branching out to other NIH institutes seemed to be a very effective way to disseminate our message about the importance of funding musculoskeletal research. It was a clear signal that we needed to focus on establishing relationships, relaying our message and considering a multi-disciplinary approach.

At a strategy session to establish our agenda, we decided to be proactive and focus on the most promising areas of musculoskeletal research. We also established a list of specific requests, including securing seats on Institute Advisory Councils, opportunities to collaborate with various institutes on annual research symposia and potential funding in cutting-edge research areas. Finally, we decided to offer our research expertise and leadership in orthopaedics/musculoskeletal research disciplines.

At Dr. Katz’s invitation, several institute directors also participated in the meeting, including: Roderic Pettigrew, MD, PhD, director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB); John Niederhuber, MD, acting director of the National Cancer Institute; Vivian Pinn, MD, director of the Office of Research on Women’s Health, and Judith Salerno, MD, deputy director of the National Institute on Aging (NIA). Dr. Zerhouni participated by teleconference.

Our first presentation provided an overview of the burden of disease and its impact on quality of life for orthopaedic patients. We discussed the importance of clinical trials and the budget realities of funding projects on biomarkers, registries and understanding chronic pain.

A second presentation focused on new directions in gene therapy and tissue engineering. Investment in these fields now could generate exciting results, and recruiting and retaining scientific talent to pursue these areas is a priority. Research advances in bioengineering, surgical technology, biomaterials and imaging can help develop improved treatment modalities for patients with musculoskeletal diseases. The final presentation covered the importance of sex, gender and age on pain response and clinical trials.

The NIH response

Afterward, Dr. Zerhouni acknowledged that musculoskeletal conditions do not necessarily have a high mortality rate, but stressed that they do have a tremendous impact on the public’s health and quality of life.

He also underscored the importance of patient advocacy groups, which are better able to bring this message to legislators. For the past three years, the AAOS has included patients in Research Capitol Hill Days, when patients, physicians and researchers visit Capitol Hill to meet with the representatives of the appropriations committees. The AAOS is also in its third year of developing a patient advocacy group. Dr. Zerhouni encouraged the Academy and ORS to consider partnering with other advocacy groups such as AARP for maximum advocacy impact. Dr. Pinn suggested working with the Older Women’s League, which is very invested in researching aging issues.

Dr. Zerhouni also expressed his concern over the available manpower in the field of orthopaedic research and the effect this could have on our ability to address many growing opportunities. This underscores our commitment to encouraging more orthopaedists to become clinician scientists.

Finally, he encouraged us to find new ways to educate Congress about the huge burden of disease and its consequential impact on society. In the current low-growth budget environment, such information can be used to support funding measures.

Involving other Institutes

Later, we met with Dr. Pettigrew, NIBIB director, and provided him with a full report. Although the NIBIB is a relatively young institute (established in late 2000), it has noted a two-fold increase in the number of grant applications received. During the discussion, we learned that the annual budget of NIBIB is almost half that of the NIAMS budget. Further discussions will focus on collaboration on potential research symposia topics and the possibility of adding AAOS and ORS seats on NIBIB’s Advisory Council.

We also met separately with Dr. Salerno and several NIA representatives to discuss cooperative efforts on fragility fractures, chronic pain and comorbidity issues. Dr. Salerno noted that recovery from sports injuries, illness and surgeries was also of interest to the NIA. Although she felt these areas were not well-studied, they provide opportunities for an interdisciplinary approach.

These interactions with NIH leaders have reinforced our commitment to federal advocacy for musculoskeletal research. The meetings have also served to emphasize the tremendous burden of disease associated with musculoskeletal disorders and the need for continued and increased investment into clinical and basic research in this area. We look forward to enhanced collaborative relationships with several NIH institutes.


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