NIH Funds Help DCVAMC, Partners Tackle Health Disparities

by U.S. Medicine

February 22, 2011

WASHINGTON, DC—“Historically, it takes many years and lots of research money to go from the initial concept—an idea created in a lab—to the few of those trials that are successful and actually change clinical practice,” said Marc Blackman, MD.

Blackman, associate chief of staff for research and development at the Washington DCVAMC, believes this pattern of slow growth from bench to bedside may be changing, thanks in part to partnerships fostered by NIH. “Several years ago, NIH began what they referred to at the time as a clinical research roadmap,” Blackman told U.S. Medicine. “NIH decided that the essential mission of research should be to bring the best of basic science to clinical trials and the best of clinical trials to clinical practice more quickly than has historically been done in the United States.”

One of the ways NIH is helping do this is through its Clinical and Translational Science Awards (CTSA), which are provided to consortiums of medical and research facilities, including the DCVAMC.

Targeting Health Disparities on the Hill

The DCVAMC has had long-standing partnerships with other providers in the DC area, including Georgetown University and Howard University. Those two universities, along with the DCVAMC, Oak Ridge National Laboratory in Tennessee, and MedStar Health – an integrated healthcare system that includes nine major medical centers in DC and Baltimore, form a consortium that this summer was awarded $38.2 million over five years.

The goal of the consortium is to improve research and treatment for underserved populations locally and nationally, with the belief that they can accomplish more as a group than they ever could separately. “We are now in the process of beginning to implement the structure of this very complex inter-institutional research system,” Blackman said. “The major goal overriding all of this is reducing health disparities in our nation’s capital.”

While it is relatively well-known that Washington, DC has one of the highest HIV rates of any city in the country (3% compared to 0.6% nationally), the city also has high rates in other diseases, including obesity and heart disease. According to a 2009 report commissioned by the Metropolitan Washington Council of Governments, there is a 10-year difference in life expectancy depending on what area of the city a person lives in; and the infant mortality rate is 2.5 times greater in the jurisdiction with the highest rate compared to the jurisdiction with the lowest. The percentage of the population that is considered obese ranges from 14% to 26%, and the percentage with high blood pressure ranged from 14% to 27%, depending on what area of the city was examined.

“I think it’s pretty clear to all [who] know Washington, DC, that it is a city where there are a variety of ethnic minorities and where health disparities are really important from a public health perspective, whether they be the epidemic of obesity or HIV or HIV/AIDS or hypertension or vascular disease,” Blackman said.

Partnering on Translational Science

The CTSAs are, in essence, infrastructure support grants. They allow consortiums to pay for space, personnel, and training. The Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), of which Blackman and DCVAMC are a part, will use its $38 million to integrate existing research and training programs with a newly-created infrastructure to enhance practice, laboratory, and community based clinical and translational research.

The program will include a coordinated multi-institutional biomedical informatics infrastructure, an expanded clinical research operation with new community-based clinical research units, a new community engagement resource to support and enhance community-based research, and expanded resources in regulatory knowledge and ethics.

“We’re all very excited about this, because each of these institutions has long-standing clinical and research interactivity with every other,” Blackman said. “This award fosters even more interdisciplinary and inter-institutional activity in a way that will benefit enormously the advancement of research in the context of improving tomorrow’s health.”

The one partner in the consortium that is a relative stranger, at least to DCVAMC, is the Oak Ridge National Laboratory. Oak Ridge has one of the largest supercomputing capabilities for peacetime and biomedical use in the world. It had previously collaborated with Georgetown on large-scale pharmacogenomic studies. That computing power will now be focused on the development of novel translational methodologies—speeding the development and application of new technologies to improve health. Data will be collected and analyzed in an attempt to better understand the pathogenesis of disease; develop new techniques to diagnose and treat disease; and to assess the best ways that resources can be allocated into specific areas in the community.

“At DCVAMC, we’re hoping to play an important role. We see this as an opportunity, because of the size of the consortium and because of geography, to do good things for veterans and non-veterans in our area,” Blackman said. “This consortium will be one of many nodes in a patient-oriented national research network—the jewel in the crown of clinical and translational research nationally.”

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