• The environment for health research is changing rapidly at academic health centers, managed care and industry. In response, paradigms about training physicians and PhDs need to change as well.

• Private organizations may be able to increase their impact by funding "risky" or politically unpopular research.

• With the changed health care system and the advancement of new technologies, many new research opportunities are arising, especially in the area of new emerging fields and interdisciplinary research. Some examples include genomics; neuroscience; interfaces in science such as mathematics and biology or physics and biology; and biotechnical ethics. Since these fields are new, scientists can run into difficulty securing funding for these areas.

• Translational and clinical research -- the kind of work that speeds results from the research to the bedside -- has been hit especially hard in recent years. The private funding community may be able to help ease this situation by devoting greater resources to clinical research, which is broadly defined as including patient-oriented research, epidemiologic and behavioral studies, as well as outcomes research and health services research.

• Private organizations should increase their support of behavioral research, which is essential for preventing and treating disease.

• Public understanding of science -- from encouraging young children to pursue science-based careers to helping adults grasp the importance of research -- is critically important.

• Foundations, voluntary health organizations and research organizations need a regular forum where they can exchange ideas and clarify their roles.

In light of the dramatic market changes that have taken place in the health care industry in the past several years, meeting participants agreed that major changes need to take place in the training of scientists. Young researchers are finding it increasingly difficult to move beyond the post-doctoral stage -- PhDs can remain in training for 10 years or more. Meeting participants noted that although the National Institutes of Health (NIH) budget is higher than ever, research dollars and traditional positions in academe have become scarce as more people compete for resources. Greater effort is needed, therefore, to inform students as to where the jobs are likely to emerge, and what training will be required. The participants called for creative thinking about new career pathways that are not limited to academe or industry.

Under the umbrella of new paradigms for training, participants also mentioned the need for better systems of mentoring. For instance, some suggested the possibility of paying mentors in clinical research. Participants also called for the establishment of multi-disciplinary training with an eye toward moving away from the "silo" phenomenon (for example, where physicians train only with physicians, or nurses train only with nurses), and the creation of multiple career pathways.

On the research side, meeting participants noted that one of the crucial areas in which private funders could make a difference would be to fund "risky" or politically unpopular studies in fields such as reproductive, substance abuse, international health/disease and social and behavioral research.

With the new health care environment so focused on reducing costs, clinical research is under strain. Physician scientists who once combined clinical care with research studies now must spend more time treating patients. The existing system makes it difficult for many MDs to compete with PhDs for research dollars. Between 1992 and 1994, the number of MDs applying for NIH grants declined by 30 percent. Physician scientists are facing an "either/or" choice between clinical practice and research, even though their special strength is to combine the insights of both approaches.

Participants at the meeting discussed ways of strengthening clinical research and heard from NIH Director Harold Varmus about new NIH initiatives to address the problem. Participants also discussed the need for additional resources for translational and biobehavioral research, and noted that the area of health services research could benefit from additional resources. For instance, between 1970 and 1994, federal health expenditures grew from $18 billion to $328 billion, about a 1700 percent gain. During that same time period, funding for federal he



Joann Schellenbach
National Director Media Relations
American Cancer Society
212-382-2169
jschelle@cancer.org