2009 James B. Herrick Award and Lecture—Clinical Research at the Crossroads
Cardiovascular clinical research is experiencing unprecedented pressures in funding and manpower at a time when there are also unprecedented needs to expand the cardiovascular portfolio in translational research, outcomes research, and comparative effectiveness research. The clinical cardiovascular investigator is literally experiencing the best of times and the worst of times. Funding for the NIH, which increased at an annual rate of 15% during the years of doubling of the NIH budget from 1998 to 2003, has been essentially flat since 2003. NHLBI pay-lines for RO1 applications, which peaked at 35% in 2001, have steadily declined to 15%. The average age at which investigators receive their first NIH grant is 43 years, and in 2004, 44% of NIH awardees were over the age of 50 years. The deceleration of research funding, along with the real or perceived challenges facing young investigators in obtaining mentorship and funding, has had a chilling effect on attracting the brightest aspirants to pursue careers in clinical investigation. Simultaneously, junior cardiology faculty face increasing demands for clinical RVU productivity by their institutions because of shrinking reimbursement for clinical care, which often pushes them into private practice. These pressures are mounting at a time when there are pressing needs for clinical investigators to confront the continuing global epidemic of cardiovascular disease, which can only be overcome by innovative advances in translational, outcomes, and comparative-effectiveness research. The two highest priorities for comparative-effectiveness research in the 2009 Institute of Medicine report were studies in healthcare delivery systems and cardiovascular disease. Through the collective scientific and advocacy efforts of all of us in the community of science and medicine, these remarkable challenges can be overcome.