Dr. Bracken sees cutting funding as the wrong approach. Rheumatic diseases are influenced by genetics, environmental and socioeconomic factors, and work related to DEI has important implications for patient care, she points out. “But there is an opportunity here to reform the way that we fund scientists. There are a lot of inefficiencies in the way that we currently do things, and there’s an opportunity for us to evaluate the system and improve it.”
“We continue to move ahead and pursue our research,” says Dr. Kuhn. “But we’re realistic, and we’re listening carefully. I think the key thing will be how we pivot in response to changes in the way funders want us to focus our research.”
Personnel Challenges
The resourcing challenges of rheumatology research extend beyond money. The rheumatologist shortage, projected to worsen over coming decades, may limit not just clinical availability but also the availability of MD/PhDs to perform important translational work in rheumatology. Even before the most recent research concerns, many people dropped out of their research career track between receipt of an NIH career development award (K series) and obtaining an R01-level project grant.2
The time pressures can be intense for academic physicians, as they balance tasks such as clinical responsibilities, teaching, direct research and other indirect research tasks such as administrative responsibilities. In addition to funding concerns, a survey found that poor institutional research infrastructure, local politics, lack of mentorship and unclear career developmental pathways were also associated with the choice to leave research.2
“One of my biggest concerns is that we’re going to see an exodus of individuals from research careers,” says Dr. Kuhn.
Challenges Inherent to Rheumatology
Researchers in rheumatology also face additional challenges from the nature of the topic itself. For example, many rheumatic conditions are relatively rare. Dr. Behrens points out that this sometimes makes it necessary to perform collaborative, multi-center studies to recruit enough patients. However, he also emphasizes that, taken as a group, rare diseases are the most common type of medical condition, so they definitely deserve scientific study.
Many rheumatic diseases display variable presentation, making them difficult to definitively classify and diagnose. Treatment response can also vary significantly, which can make it difficult to define the right trial end points. And some of the most important outcomes of rheumatic diseases, like pain and fatigue, are hard to objectively measure, all posing challenges for study design. Additionally, the chronic nature of these diseases often means that long-term trials are needed to fully evaluate response.
