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Glory Days Celebrated, Sought
First Clinical Research Day Builds Past into Future

By Carla Garnett

On the Front Page...
Nearly 50 years ago, NIH was poised to transform itself and the way medical research was conducted. In July 1947, Congress authorized more than $30 million in construction funds for the agency to build a 600-bed clinical research hospital. Since then, the Clinical Center has been the site of dozens of breakthrough cures or treatments for everything from acne to vasculitis.

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Now, history seems about ready to repeat itself, as NIH is once again on the threshold of building a grand new Clinical Research Center. The first Clinical Research Day held Feb. 10 put the two similar eras in perspective, featuring a glance at the past by NCI deputy director Dr. Alan Rabson, a view of the present by CC director Dr. John Gallin and a look into the future by NIH director Dr. Harold Varmus. The day also included scientific presentations and workshops, poster sessions and a sneak peek at the new facility's latest architectural plans.

Moments of Discovery

Rabson, who came to the CC in 1955 and spent 20 years there as a pathologist, reminisced -- at times, humorously -- about some of the early days of clinical research in the hospital. He recalled the dedication to patient care and the vision of the first CC director, Dr. Henry Masur. He also remembered a research climate dominated solely by unlimited scientific needs and largely unfettered by administrative and regulatory red tape.

"There was a minimum of administrative overlay," he said. "Research was the only goal."

Mentioning a few of the great medical advances realized at the CC, he called to mind treatments for Niemann-Pick disease, acne, vasculitis and chronic granulomatous disease, as well as the development of such medical devices as the high-speed dental drill. He also made a prediction:

"The new Clinical Research Center will be a place where major advances in clinical research will be made, and major advances will be made by people in this room, at this time."

Evoking words from the first medical board meeting held in the CC on June 9, 1953, Gallin said despite strained fiscal circumstances, increasing distractions of regulatory oversight and the changing health care delivery system, "patients must be part of the research team."

Dr. John Gallin

He outlined key elements of his vision for a reinvigorated clinical research setting. Some elements are already in progress, such as establishment of a CC board of governors, creation of the NIH Guest House for patients and their families, and reinvention of CC administrative processes including new initiatives in procurement and personnel and a new cost accounting system. Longer term proposals include establishing clinical training programs for researchers, "harnessing the power of the information age by increasing the CC budget from 1 to 5 percent for informatics," forming a new Clinical Bioethics Program to explore such issues as privacy and genetic testing, and forging new alliances with NIH's grantees.

"We'd like to open the doors of the Clinical Center to extramural investigators to allow more collaboration with intramural scientists and to give extramural scientists access to some of the special resources," Gallin continued, citing the CC's investment in telemedicine technology and the upcoming opening of the hospital's new stem cell facility.

"My goal is for every clinical investigator in the world to spend time at the Clinical Center -- whether for training, long-term career, collaboration or utilization of special resources," he concluded, "and that every patient with a medical problem will know about the Clinical Center and turn to the NIH for advice and, when appropriate, participate in an NIH protocol somewhere in the United States."

On Goldilocks' Quest

Architects have a lot in common with scientists, intimated Robert Frasca, whose firm, Zimmer Gunsul Frasca Partnership, won the reportedly tooth-and-nail competition to design the $310 million Mark O. Hatfield Clinical Research Center. "You go through a lot of trial and error, it's very labor intensive, and there are no short cuts. The difference is that, where you all deal mostly with the laws of nature, we deal much more with human perception."

On hand to give a preview slide presentation on where design plans are headed, Frasca said the new center "will be the focus of the entire campus," featuring bookstores and other retail enterprises as well as sky bridges that will connect building wings and plenty of open atria that will encourage informal confabs.

"Interaction is fundamental to the whole design," Frasca explained, pointing out several gathering areas inside and outside the proposed structure on which construction is scheduled to begin soon. Other designer touches mentioned include bay windows for the lab areas, a waterfall outside the patient lounge, and a lobby hearth. The dimensions of the labs and the patient care areas will be standardized so that they are interchangeable and can be easily rearranged as research priorities change over the years. Also, the scale of the building will be much lower than the existing CC, "putting the building on a more human level," Frasca said. In addition, the infrastructure components -- heating/cooling system, plumbing -- of the new facility will be located above each floor, so that repair and renovations to them will not interrupt the clinical work going on below.

Frasca said the slides and design elements are the result of a number of interviews with NIH researchers, hospital administrators and other future inhabitants of the CRC, and that he hopes feedback and ideas will continue to flow between the designers and the folks who will call the Hatfield Center their new home.

"We compare this process to the one that Goldilocks went through -- we don't want it too hot or too cold or too tall or too short. We want to get everything just right, and you all are the only ones who know what just right is."

Once and Future Excellence

In his look toward the future, Varmus said NIH's traditional strengths -- outstanding science and personnel -- will need to be relied upon to address the serious hurdles current researchers are facing in pursuing patient protocols. An overall shortage of funds for science, the burgeoning trend toward managed care and the long-term debts associated with conducting clinical investigation are just three of the many challenges, he said.

"We must consider the value of the research we do with every dollar we spend," he said, listing three categories into which current concerns can be placed -- administrative, recruitment, and interest and excitement.

Varmus said in the next few months he will establish a working group of NIH's best investigators to brainstorm about ways to maintain the standard of excellence of clinical research at NIH. In addition, he said, greater emphasis must be placed on training, because energy generated by students brings in new ideas and keeps the scientific atmosphere fresh.

Dr. Monica C. Skarulas (c) of NIDDK and Dr. Maria L. Turner (r) of NCI discuss their poster collaboration during Clinical Research Day.

A new training initiative based on the success of the Howard Hughes Medical Institute model will begin this fall at NIH, Varmus continued. Already, about 75 applications have been received by NIH deputy director for intramural research Dr. Michael Gottesman, who advertised the program at medical schools nationwide. Also under consideration is an NIH Ph.D. program that would require candidates to spend time conducting clinical research.

"As we undertake this critical thinking about clinical research," Varmus concluded, "we must remember that like anything else there is good clinical research and some that is not so good. Today, we are focusing on this building and its 44 years of success, and yet we must remember we are working in the context of a much larger scientific enterprise."