Eulogy for the Metabolic Clinical Investigator?

A recent editorial in the Journal of Clinical Investigation by Nathan et al. (1) dwelt on the decision to cease direct National Institutes of Health (NIH) funding of Clinical Research Centers (CRCs). As the authors rightly point out, the lack of extramural support for the CRC infrastructure will doom this valuable resource for human research at academic institutions without the wherewithal to support clinical research. CRCs as they currently exist might no longer require NIH support if we already knew the entirety of human physiology as it relates to disease or if entities such as industry would fund the studies needed to understand the primary mechanisms of complex human disease. We are certain the former is untrue and highly doubtful the latter will occur. The subsequent demise of the CRCs and our diminished ability to perform complex, mechanistic studies in humans will have both immediate and long-term adverse effects on biomedical research. Support obtained by the NIH Research Project Grant (R01) mechanism will be insufficient to maintain the necessary research infrastructure. Consequently, investigators will abandon comprehensive, mechanistic studies in humans because of the costs involved. The eventual fall in the number of investigators capable of designing, conducting, and interpreting such studies threatens to make the U.S. a second-tier biomedical research environment.This is especially important for the field of diabetes and metabolism where related human studies account for a significant proportion of CRC use. Certainly, rigorous metabolic research requires meticulous control of diet and activity prior to study. Moreover, ensuring participant safety with intensive monitoring often requires extended inpatient stays. The elimination of the NIH-supported CRC system will also substantially constrain the infrastructure necessary for intensive human studies, such as those requiring tissue biopsy, vascular catheterization, and frequent sampling of the …