The Future of Pediatric Research Looks Bright

Six new investigators began research projects supported by Research Scholar Awards from the American Digestive Health Foundation (ADHF) in July 2000. Of these six, five were either pediatric gastroenterologists or basic scientists working in departments of pediatrics. Their areas of investigation span the whole range of science in pediatric gastroenterology and hepatology, including the cloning of a liver iron transporter (Dr. Hiromi Gunshin, Children's Hospital, Boston), the molecular basis of liver regeneration in pediatric liver disease (Dr. David Rudnick, Washington University), the basic mechanisms regulating liver cell volume (Dr. Andrew Feranchak, Children's Hospital University of Colorado), the pathogenesis of H. pylori-mediated intestinal disease (Dr. Nicola Jones, The Hospital for Sick Children, University of Toronto) and the fundamental mechanisms governing endocytosis across the intestinal epithelium (Dr. Anne Wolf, Children's Hospital, Harvard University). Each of these projects share several aspects in common, including the enthusiasm and energy of the principal investigators involved, the exciting questions being addressed, and the potential for each of these research studies to yield information that will be of direct benefit to pediatric patients with gastrointestinal and liver diseases. As chair of the Career Development Task Force of the American Gastroenterological Association (AGA) that interviewed the candidates for these awards, I personally can attest that the entire committee was impressed and inspired by these bright young investigators who represent the future of the pediatric subspecialty, as well as by the remaining “non-pediatrician” award winner, Dr. James Lilliard from Morehouse School of Medicine. Much has been written lately about the challenges faced by those seeking a career in biomedical investigation, particularly those who represent the endangered species of the physician-scientist. The obstacles involved in successfully establishing oneself on such a career path can be imposing for pediatric gastroenterologists, who may find themselves working in academic divisions with few colleagues and correspondingly large clinical loads. These challenges may have led some of our brightest trainees to turn away from the research track to pursue careers in practice. This is particularly sad at a time when the opportunities to translate basic advances in science into improvements in patient care have never been better. The pace of such translation only can increase in the coming years, as information from the human genome project provides new insights into the basic mechanisms of the most intractable diseases. However, it also takes much longer to become an effective and well-equipped investigator in the current era of molecular medicine. The standard three year fellowship, even if focused heavily on investigation, is unlikely to provide an M.D.-trained individual with the tools needed for an independent research career. At the same time, the fiscal pressures encountered by many, if not most, academic departments have limited the extent to which institutions can protect and nurture the careers of their junior faculty recruits. These issues underscore the importance of extramural awards that help to bridge the gap between fellowship and independent status, allowing new investigators the time they need to develop the concepts and expertise that will underpin their subsequent research efforts. The aforementioned Research Scholar Awards given by the ADHF represent the flagship program of the AGA and are targeted at newly-appointed faculty. They aim to protect new faculty from excessive clinical and teaching commitments, allowing them to focus on developing a creative research agenda. The amount awarded recently has increased in recognition of the fact that many award winners have numerous outside obligations such as loans and family needs. There also are other opportunities for research support and training. For example, the Children's Digestive Health and Nutrition Foundation has initiated Young Investigator Awards in partnership with industry. Similarly, the ADHF Fellow/Faculty Transition Award targets individuals at a somewhat earlier stage and allows them an additional period of training under the guidance of a preceptor who tutors them in state-of-the-art approaches to research questions. Several additional private foundations, as well as the National Institutes of Health, also offer career development awards, many of which are under-subscribed. Another critical factor ties together the investigators discussed in the first paragraph of this commentary. Without exception, they are the beneficiaries of excellent mentoring relationships within and outside their institutions. It probably is not an exaggeration to argue that few, if any can succeed in academia without the care and concern of an unselfish mentor. The pediatric gastroenterology community should congratulate itself on having captured such a disproportionate share of last year's ADHF Research Scholar Awards. However, we all need to look to our own day-to-day behaviors to ensure that this record continues not only for pediatricians, but also for internists and basic scientists. Those of us who have been privileged to enjoy a career in investigation have an obligation to share the accumulated wisdom we have gained regarding the unwritten rules and the vagaries of academia, grantsmanship, and research question selection. We should not let our own responsibilities distract us from this vital role, no matter how frustrating our dealings with deans, department chairs, journal editors, and study sections might be. Only by projecting a realistic yet optimistic view of the rewards of a career in basic or clinical investigation, while taking true satisfaction in the successes of our trainees in the absence of any direct personal gain, can we ensure the future of our discipline and the full realization of the current promise in biomedical science.

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