Thursday, November 13, 2008

2nd lesson learned from NCI Translates

Okay, so no word on the biopsy results yet. While Lynley and I are both completely ecstatic with the findings of the aspirates, I find it necessary to continue my act of mental disobedience by continuing to boycott my worry. Today I will address my second lesson learned at NCI Translates.

As I mentioned yesterday, the whole point of NCI Translates was to speed up the research process. This isn't an easy task. I often hear people advocating for all kinds of ways to speed up research but, to be honest, the efforts usually have the opposite effect. Speeding up the cure is not as easy as throwing more money at the problem or funding different research or researchers. It goes far deeper than that. The biggest problems appear, to me at least, to be political and financial in nature - but not the way you think.

In order to speed up the research process the NCI spent several years evaluating their successes. They dissected each successful translational discovery and broke it into it's individual steps. By doing this they were able to identify these "road maps" which showed all of the steps necessary to successfully translate discoveries from the bench to the bedside. This is good and important. Now, anyone can look at these road maps and see exactly all of the steps needed to translate science. This should help to speed up science in that the NCI now hopes to fund along this continuum. They are planning to fund people who have translational goals. With more people pursuing translational science their are more people working productively toward the end goal - a cure. We are more likely to get there more quickly with more people working on the problem in a productive way. Period.

As I addressed yesterday, they are also likely to speed up the process by the mere fact that people are following the road maps. Now that scientist are aware of what comes next they are more likely to work on achieving the goals of translating the entire project as well as their tiny piece. They are likely to address intellectual property and political issues more quickly because they now know that they will becoming ahead of time. Think of it this way. Research is done in this way. When a researcher gets hungry at about 6:00 PM he starts heating the oven up to cook his dinner. He then waits for it to heat up. Once heated he gets the food out and prepares it to be cooked. He then cooks it in the oven. An hour later his dinner is finally completed and he can commence eating. The problem is that now he has been hungry for an hour before he starts to eat. Now, what the road map provides is a plan. If the researcher looks at his road map he knows he will be hungry at 6:00 PM. Knowing this he begins heating the oven at 5:00PM. In this way his meal is completed at 6:00 PM when he knows that he will be hungry. No time wasted and he gets his meal on time. It is the same way with research. Researchers are currently trained and rewarded to work on one discreet project after another with little thought on what comes next. This new way of thinking encourages them to work concurrently, hopefully speeding up the process.

Another way the road map helps to speed up the research process is by helping leaders to prioritize research. Face it, we have limited resources and patients. That fact is not going to change. In fact, with the economy going in the direction it is going I would expect budgets to become even more constrained. It is not going to change. You may think it is our turn. Well, the problem is everyone thinks it is their turn. It is not going to change unless we change it ourselves. I am sorry to be harsh but it is a reality. The point is that prioritization becomes even more important. It becomes critical that only the most promising projects are carried forward. In other words, if your preclinical research does not support dramatic changes in survival then it needs to be put aside in favor of projects that have more promise. Wild goose chases and suboptimal research will only slow down the process by stealing resources from more promising research. This road map will help to prioritize work.

Unfortunately, this will not help pediatrics and "rarer" cancers. They will focus on the biggest bang for the buck. The NCI will focus on research that will have impact on the greatest number of people. For us that means we have to prioritize our works as well. We have to focus on targets and drugs which also have applicability in other cancers. In this way we will find financial support for our projects. I am happy to say that their have been several examples of this done well. The NANT, TXCCC, CHOP, MSKCC, and St. Judes have been successful in finding promising therapies for children with neuroblastoma that also has applicability to larger diseases. This helps us all. The other thing that we can do is to hang our research on the coattails of promising projects in more popular cancers which also has applicability in neuroblastoma. Ultimately this is the research which will be carried forward. We need to be mindful of this and figure out how our children can benefit from this research. When I get a chance to explain my 3rd lesson from NCI Translates I will show some very specific examples of research we (the neuroblastoma world) need to be following very closely for this reason. There are several promising research projects in lung, breast, and colon cancer that could have dramatic impacts on children with neuroblastoma that we need to be on top of. This opinion is not my own. It was shared my several neuroblastoma researchers that were present at the meeting.

As I thought about all of this I really felt that the "road maps" or "pathways" added value. But, in another sense I felt that they were still missing the boat. The pathways were modeled after successes - successful translational research. However, they weren't modeled after the successes that necessarily took the shortest time to complete. While the pathways were pretty accurate at describing every step in the process it offered no guidance on how to complete each step as quickly, efficiently, and accurately as possible. In this sense, their is still no reward for completing the work quickly. There is nothing definitive to speed up research. This is a problem. I don't have the answer here but I certainly offered my suggestions. This was my job as an advocate. Bottom line, the pathways will help to speed up the process but there is more that can be done. We need more creative thinking. We also very desperately need a definition of what research needs to be carried forward and what needs to be abandoned. We, the world of cancer, are still wasting resources.

As I sit here and think, I have decided I have a fourth lesson to be learned from the NCI. This comes under the heading - pharmaceutical companies are good investments for you extra dollars but horrible investments if you want to cure cancer. The answer is out there. Right now. Unfortunately, like 1000s and 1000s of drugs, it is sitting on a shelf in a pharmaceutical company not being carried forward because they don't believe it is profitable enough. You think I am crazy. Just wait to you hear what I have to share.

Well, I had best be off. It is time to focus on my little purpii.

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