The past several years have been difficult for biomedical research in the United States, and pediatric research is no exception, with the recent recession meaning funds have tightened even more at some children鈥檚 hospitals. But some pediatric researchers see reason for optimism in the Obama era, in pending legislation to create collaborative children鈥檚 health centers, and in the promise of major advances in key pediatric health areas. 鈥淚t鈥檚 an exciting time for children鈥檚 health research,鈥� says Laura Feldman of the National Association of Children鈥檚 Hospitals and Related Institutions in Alexandria, Virginia. 鈥淭here are a lot of opportunities out there.鈥�
Collaborative consortia
During the 20th century, the number of children鈥檚 hospitals in the US and Canada mushroomed. While many children are still treated at normal hospitals, families often choose pediatric hospitals when facing rare but serious childhood conditions. Today, many children鈥檚 hospitals continue to treat their patients as they grow into adulthood 鈥� a testament to advances in research and care.
Because of pediatric research advances, 鈥渢here are kids alive today who, a few decades ago, would not have been alive,鈥� says Edward McCabe, chair of pediatrics and physician-in-chief of Mattel Children鈥檚 Hospital UCLA. 鈥淭hey鈥檙e even living into adulthood and having families. It鈥檚 amazing the changes we鈥檝e seen.鈥�
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Some of this progress came out of collaborative networks of researchers focusing intense effort on specific problems. For example, pediatric oncology consortia originally formed several decades ago have led to huge advances in treating childhood cancers, says James Hendricks, president of Seattle Children鈥檚 Research Institute in Washington. 鈥淭en or 15 years ago, pediatric cancer had a mortality rate of close to 50 or 60 per cent. Now it鈥檚 more like 10 or 15 per cent. This is a direct result of the work of that consortium.鈥�
Legislation currently in Congress could allow the formation of new collaborative centers devoted to other children鈥檚 diseases. The National Pediatric Research Consortia Act, introduced in both the Senate and the House of Representatives in March 2007, would authorize 20 such centers. In a hub-and-spoke model, a central children鈥檚 hospital plus other aligned institutions would cooperate to address a particular problem, with annual NIH funding of $2.5 million for each center and its partners.
Such collaboratives encourage focus and a core support system on which to build, says Arnold Strauss, director of the Cincinnati Children鈥檚 Research Foundation and chair of pediatrics at Cincinnati Children鈥檚 Hospital Medical Center in Ohio. 鈥淭hat is a major push for all of us interested in research in pediatrics.鈥�
Many researchers hope that the funding atmosphere will improve with the Obama administration in office. The president鈥檚 economic stimulus plan will provide an additional $10 billion to NIH over two years, which has caused 鈥渁 great deal of excitement in the research community鈥�, Hendricks says. For example, Seattle Children鈥檚 went from a typically monthly submission of 20鈥�25 NIH grants to 106 grants submitted in April for stimulus dollars. 鈥淥f course, the competition is going to be stiff,鈥� he says. 鈥淏ut I think it demonstrates that the research community is really interested in trying to make something out of the stimulus dollars.鈥�
Research prospects
The excitement around improved support stems partially from the feeling that researchers are poised to make major inroads into pediatric illnesses. 鈥淚 think it鈥檚 the best time ever to study pediatric disorders and prevention,鈥� Strauss says. The tools to study congenital birth defects and to pinpoint genes underlying genetic disease should allow rapid advancement in treating those illnesses, he says.
At UCLA, researchers are studying the benefits of nanotechnology in pediatric medicine, McCabe says. 鈥淲e鈥檙e trying to make sure that diagnostic and therapeutic approaches at the nanotechnology level are safe and effective for children.鈥�
UCLA also has faculty working on developing non-invasive stents and valves for kids with congenital heart disease. Although such devices are now commonplace for adults, developing safe and effective child-sized devices has been a longstanding problem.
In addition, children鈥檚 hospitals and pediatric departments are putting a lot of effort into vaccine development, basic and clinical autism research, and prevention of premature birth, as well as investigating many diseases that affect adults, including obesity, type II diabetes, and hypertension, which are believed to begin in childhood. 鈥淢ost adult diseases start in childhood and, if we don鈥檛 learn how to treat them in childhood, it鈥檚 not going to change,鈥� says Strauss.
Overcoming obstacles
Concern remains that advances in pediatric medicine will continue to suffer from a lack of financing, however. In fact, many scientists and doctors who focus on children鈥檚 health feel that pediatrics is consistently shortchanged when compared with adult diseases 鈥� in part because these tend to be widespread, while many childhood disorders are severe but rare.
Increased difficulties since the recession are forcing some pediatric departments and children鈥檚 hospitals to downsize. Charles Irwin, professor and vice chair of pediatrics at the University of California, San Francisco (UCSF) School of Medicine, suspects that UCSF will cut back on the number of researchers they employ, mainly because they won鈥檛 be able to afford to supplement the salaries of their investigators whose federal grants may cover only 50 per cent of their salaries.
While this may be a common theme at state-funded institutions, not all children鈥檚 hospitals are reacting in the same way. For example, Seattle Children鈥檚 Research Institute is currently expanding facilities and recruiting 10 new scientists this year. Because other institutions are struggling financially, more scientists than usual may be willing to move, says Hendricks. 鈥淣ow is the time to go out and try to find the best candidate.鈥�
A similar strategy is in place at Cincinnati Children鈥檚 Hospital. 鈥淲e get really good people from other places that aren鈥檛 doing so well,鈥� says Strauss. 鈥淲e鈥檙e adding research staff at a pretty significant pace and I anticipate that we鈥檒l continue to do that.鈥�
To help with funding, pediatrics at the University of California, Los Angeles (UCLA) looks to foundation money, says McCabe. 鈥淲e鈥檙e trying to keep everybody going, because we鈥檝e got a strong research program,鈥� he says. 鈥淲e know it will be harder to rebuild it than to try to keep it going through the difficult times.鈥�
Pediatric researchers are clearly passionate about the work they do, despite the current funding challenges. 鈥淚 recognize that everybody wants to scrimp, but it鈥檚 important to recognize that we can change the futures of the children who we claim are our future,鈥� says Irwin. 鈥淲e just need to invest in it appropriately.鈥�