CTSAs Investigated

Lynn Morrison, President of Washington Health Advocates, a Washington lobbying firm that represents the American Federation for Medical Research et al., has published a commentary entitled “The CTSAs, the Congress, and the Scientific Method” in the current issue of the Journal of Investigative Medicine.

I’m not at all surprised by the moaning & gnashing of teeth by former GCRC affiliates, but a “Private Investigator” who formerly headed up a K30 program bluntly states, “The CTSA appears to be a disaster.” This is surprise given the successful training program where I am, though perhaps it is doing so exceptionally well in spite of rather than because of the CTSA. However, some of the other anecdotal comments in the essay ring true, and I’m surprised more was not said about the oppressive reporting requirements.

Morrison calls for a pause in awarding CTSAs after the current review cycle is completed. Given that the last two RFAs seem to be shoe-horned in before the Great Zerhouni leaves, and that the longevity of this program has been unclear from the start, this makes sense. Why should so many good research institutions invest so much time and effort trying to secure awards that sound essential but may not be sound investments?

She then suggests increasing the budget for the existing awardees, and here we part company. I think instead the program should be trimmed down and fewer requirements imposed on awardees. The CTSA person who bemoans “… we hired about 40 new people, started a bunch of new programs, and will have to renege on almost everything” would still have to sort out priorities, but better to admit these sites can’t do everything the CTSA requires and re-allocate resources to those programs that are working well and are meaningfully supporting clinical and translational research. Not every component of the CTSA program is a winner at every site.

Finally, she urges that more voices be raised about the true effect of the CTSA on clinical research supported by the NIH. My concern here would be that some of those raising objections would be doing so without full understanding of how the program operates simply because this is not well articulated at their home institution (or at least not here, based on my conversations with faculty). The good experiences are really, really, really great – the sort of transformative support that was never possible before. (These are the sort of keeper programs noted above.) Investigators encountering a bad experience could have erroneous expectations (free money for studies is a common misconception) … or they could be encountering a genuine CTSA-imposed shortcoming (especially related to former GCRC operations). But they probably wouldn’t be in a position to know the difference.

I would prefer these barriers be communicated to the army of CTSA administrators, who could add their own list of well-reasoned concerns about the program in passing on to the NIH and/or Congress an organized, thoughtful presentation that could be acted upon (versus merely raising ire). My personal opinion, which I don’t think is qualified to pass on to Congress as suggested by Morrison, is that the CTSA program, as currently implemented, was a poorly planned & hastily launched initiative built on good intentions … the sort that pave the road to hell.

1 Comment »

  1. CC said

    I have the same reaction to this as I do to proposals to solve the havoc created by the NIH doubling by throwing more money at it: step one is to get administrators who are capable of running things in a sane way (where “sane” includes designing a system that won’t collapse when a few lean years inevitably come along). Or at least an admission from the existing leaders of what they’ve done wrong and what lessons they’ve learned.

    When that happens, *then* give them more money.

    Of course, with at least another $150 billion rustling out of federal coffers to provide “economic stimulus”, the “more money possibility” becomes just that much more of a fantasy in any case. – writedit

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