Especially at the translational level, answering the next big questions in child health depends upon cooperation between institutions and collaboration among specialty fields
by Tim Bonfield
Tracy Glauser, MD, frames the relationship between teamwork and health science discovery as a building process.
Every house needs a strong, solid foundation. Yet as the structure rises, the complexity increases. Stone and concrete give way to plumbing, wiring, roofing, and windows. Bringing the components into a cohesive, healthy whole requires seeing the relationships between them, and understanding the systems involved.
“Thirty or 40 years ago, our understanding of the human body and our understanding of science was such that the unit of research as an individual made a lot of sense,” Glauser says. “An individual researcher, with a lab support team, could take on many of the questions being asked.”
In this fashion, decades of brick-by-brick foundation building has amassed today’s understandings of human development and disease.
“Now, however, as discovery has accelerated over the last 30 years, the questions have become bigger. We are beginning to realize the interplay and integration between systems. We are seeing these processes at work between molecules, cells, and organisms,” Glauser says. “There is a parallel to this in how science advances, between individuals, divisions and institutions.”
Changing questions, shifting approaches
Cincinnati Children’s, over many years, has built a strong culture of collaboration between researchers and clinicians. In pediatrics, such teamwork is a necessity.
Unlike the powerful driving forces of heart disease and cancer in adult medicine, a constellation of more than 7,000 rare diseases shapes pediatric science. For many scientists, simply finding enough cases to begin gathering information requires cooperation far beyond their own laboratories.
A similar dynamic plays out on the national level.
At the National Institutes of Health (NIH), the mostly individual R01 research grant remains the workhorse of federally funded discovery. Yet, despite an explosion of technology opening exciting new opportunities, the overall amount of R01 funding has been flat.
NIH data shows that annual funding for R01 grants has hovered between $9.8 billion and $10.6 billion since 2006.
However, the NIH has been increasing its support for team-oriented, multi-institutional collaborative agreements. The agency’s U series of grants includes funding for various “high-impact” collaborations that seek to advance new technologies and build upon breakthroughs.
In 2006, the NIH devoted $1.9 billion to four types of research-focused U grants. By 2015, the NIH had increased that funding by 46 percent to commit $2.8 billion to 14 types of U grants.
The money involved remains a fraction of R01 spending, but the direction-setting influence is clear.
Team science requires different kinds of support
“In the basic sciences, we talk frequently about the need to invest in enabling technologies. We buy microscopes, gene sequencing and editing capabilities, and so on,” Glauser says. “But team science requires different sorts of enabling technologies.”
Glauser serves as Associate Director of the Cincinnati Children’s Research Foundation. He also has considerable direct experience working in collaborative projects.
Since 2003, Glauser has been principal investigator of the NIH-funded Childhood Absence Epilepsy Study Group, which has published several papers detailing the best first-line and second-line treatments for seizure control. Overall, the group includes more than 150 scientists and clinicians working in 32 medical centers. (Read more about team science in brain research.)
The Research Foundation invests in infrastructure that supports team science, such as acquiring the hardware and human expertise needed to incorporate genomic data into research across the institution. These growing capabilities helped the medical center recently win a $32.5 million Bench to Bassinet grant to accelerate progress against congenital heart defects.
Other investments occur even deeper behind the scenes: in the legal and regulatory aspects of science. Teaming up with other medical centers also means rewriting contracts to allow data sharing, hashing out intellectual property concerns, evolving institutional review board processes, and deciding how to share the credit as well as the work.
“How do we reward team science? In baseball, everybody on the team gets a World Series ring. But in academics, it can seem like there’s only one ring to give out—to the principal investigator,” Glauser says.
Teamwork takes many shapes
Cincinnati Children’s plays leading roles in cooperative research at various levels and with a variety of funding sources.
For example, the national ImproveCareNow project brings together families, scientists and clinicians from more than 90 medical centers as a “learning network” dedicated to improving outcomes for young people living with Crohn’s disease and ulcerative colitis. The network has been such a success that it recently earned the prestigious 2016 Drucker Prize.
Peter Margolis, MD, PhD, is a Co-Executive Director of ImproveCareNow. He and colleagues in the Anderson Center for Health Systems Excellence are working to expand the learning network concept to other forms of chronic illness, including cystic fibrosis. Support for their work comes from an NIH “Roadmap” grant for transformative research and other funds from the Agency for Healthcare Research and the Patient-Centered Outcomes Research Institute (PCORI).
Cooperative projects also occur outside the traditional NIH funding pipeline.
For example, federal, state, county and charitable funds support multiple initiatives to reduce infant mortality in Ohio. These programs include Cradle Cincinnati, the March of Dimes Prematurity Research Center Ohio Collaborative, and the Ohio Perinatal Quality Collaborative.
The Center for Prevention of Preterm Birth at Cincinnati Children’s, directed by Louis Muglia, MD, PhD, is deeply involved in all these programs. The March of Dimes Ohio Collaborative includes more than 100 scientists, researchers, physicians and staff. More than two dozen public agencies and community organizations participate in Cradle Cincinnati. Meanwhile, hospitals across the state share best practices through the Perinatal Quality Initiative.
Sometimes, institutions choose to fund cooperative efforts without any public funding.
The new Genomics Research and Innovation Network (GRIN) brings together leaders from Cincinnati Children’s, Boston Children’s Hospital, and the Children’s Hospital of Philadelphia to explore ways to accelerate research on the genetic causes of disease.
The work happening within GRIN establishes the crucial ground rules needed for long-lasting institutional cooperation, Glauser says. Three research projects involving pooled data already have begun.
Challenges ahead for team science
In basic research, many important questions can still be tackled without involving dozens or hundreds of institutions, Glauser says. However, the demand for institutional collaboration at the clinical and translational level is clear and rising.
Today’s big research projects can involve hundreds of people making important contributions. Expertise may come from dozens of institutions, sometimes spanning continents. That means research centers face constant challenges finding ways to work together across highly diverse cultures and forms of governance.
“If you cannot work out these issues, you’ll never be able to do team science,” Glauser says. “But the goal is worth the effort. The ultimate outcome of collaboration is great science that helps patients.”