When I wrote about the EULAR meeting in the September and October issues of The Rheumatologist, I said that times are changing and that rheumatology should be prepared to look carefully at itself and adjust to new realities. In those columns, I focused on the improvement of outcomes in the treatment of rheumatoid arthritis (RA) and how this will change the structure of practice, work force projections, and the research agenda as remission in RA becomes more and more achievable.
By the calendar, the interval between the EULAR meeting in June and the ACR Annual Scientific Meeting, held in October 2008 in San Francisco, is not a long time, but rather a quick blink in history. Those warm and radiant days on the Champs Élysées, however, now seem like the distant past, shrouded in memory as economic uncertainty swept into our country with the force of a hurricane and flailed everything in its path.
The last few months of financial turmoil and uncertainty have probably been the most momentous for our country since the end of the Second World War, and we are only beginning to learn the magnitude of recent events. There is no Richter scale for historical happenings but, if there was, the time since the financial collapse would certainly rate as a Big One, as earthquake-like changes rattled our entire economy. Even though the ACR meeting provided an outstanding menu of science and learning, everyone could feel the afterstocks of Wall Street’s epic plunges.
Revelations at 30,000 Feet
On the first leg of my flight home from San Francisco, I swiped a copy of the Wall Street Journal (WSJ) that had been left abandoned in the first-class section. To skimp on funds, I, of course, booked the cheapest flight and sat crowded in coach, assailed by the cacophony of a man gripped by sleep apnea and stewing over the $15 baggage fee and the $1 I paid the flight attendant for a cup of bitter, lukewarm coffee. The WSJ was a welcome freebie.
Consider the following headlines of the October 29, 2008, WSJ: “Cash-Poor Biotech Firms Cut Research, Seek Aid”; “Wyeth to Focus Research Efforts on Fewer Diseases”; and “Outlook is Cut for U.S. Drug Sales.”
Those headlines don’t sound particularly good, especially at a time when the pharmaceutical industry provides a significant source of funds for both basic and clinical research. Events at the Moscone Center, San Francisco’s convention hall, may have given a different impression of the state of industry’s health. The exhibit area for the companies was huge, blaring, and boisterous, and filled with the newest in upscale computer displays and advertisements for a cornucopia of products. While the company exhibits were far away from the poster viewing area, many attendees made the trek, interested in seeing what industry had that was new, or perhaps attracted by the “lure of the cappuccino,” as one of my friends said.
At the exhibit hall, I talked with several friends who are now in industry and, interestingly, all seem energized and excited about their new life away from the culture of grant writing and publish or perish. Sadly, when National Institutes of Health (NIH) grant funding rates go below 10%, an excellent scientist can publish and perish. Under these circumstances, the opportunities of a well-financed company can seem like paradise.
I was impressed by the enthusiasm of my friends in industry. One said his company had 20 molecules ready for phase 1 testing and another said he already had five molecules in people. Those pipelines sound terrific, but moving those molecules forward requires cash. When the stock market plunges and credit stays crunched, the cash evaporates and products can languish.
Consider what happened to Savient Pharmaceuticals at the ACR meeting. Savient Pharmaceuticals is developing a new treatment for gout (By way of disclosure, Duke University, where I am a professor, has had a major role in its development). When the Wall Street analysts heard something they did not like during a plenary presentation, the stock price of Savient plummeted. The ultimate effect of this change is unknown but it could certainly complicate, if not slow, the development of a needed treatment for people with the most refractory forms of this disease.
With the current financial pressures on industry, “me too” drugs may never get their start, and even “me better” drugs may fail along the long path for approval unless they are really much better and the payoff on the investment seems big.
On the other side of the public–private partnership, the NIH struggles. With a soaring federal budget deficit in the many trillions and the immediate exigencies of the bank bailout, increases in NIH funding are doubtful and many would be happy if it just stayed stable. To its credit, the NIH is trying to preserve funding for young people and the ACR Research and Education Foundation (REF) has been visionary in supporting young investigators whose applications for K awards just miss the pay-line. Those are important trends, but it is time to engage the NIH in a serious dialog on the best portfolio for the funding of investigators, both young and old.
Resonance Between Industry and Academia
The exhibit area and poster sessions may have been at opposite ends of the Moscone Center, but these realms are really not separate. Rather, they are inextricably tied together as the boundary between public and private forever shifts and blurs. Industry and academia are not two separate mountains. In today’s flat world, they occupy space next to each other on the same wide plain and their fortunes can rise and fall together.
By nature, I am an optimist and believe that the fundamentals of the economy are strong (Have you ever heard that before?) and that the American people in their generosity, wisdom, and commitment to good health for all will one day restore the NIH and medical research to their rightful place. If so, that will be a Big One, but of the good kind.
The city of San Francisco is one of the most beautiful and vibrant in the whole world, and it is at the epicenter of biotech and computer industries. In the downtown, sleek spires of glass and steel rise triumphantly in seeming defiance of the wobbly ground beneath. While San Francisco may be the site of a big earthquake in the future, today it grows and thrives.
As always, I think of the ACR meeting as a time of education, reflection, and renewal. Of the knowledge I gained at the ACR, perhaps the most important was how to savor the sight of the bay at dawn, the sound of fog horns near the bridge, the pleasure of dining with good friends, and the myriad other things to do while waiting for The Big Ones.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.
