Fighting for the Cause: Could It Mean a Cure?
I have been thinking lately about issues related to the direction of research funding for the field of molecular imaging. I have to confess my preference for nuclear techniques in this regard since tracer techniques usually have the advantage of not perturbing the observed state. The recent report on the advantage of FDG imaging over fMRI to assess consciousness disorders supports my bias.1 I am sure that my MRI-advocating friends have a few examples to contradict me.
One observation that I have made over my career in nuclear medicine is the significant reliance our field has on Federal funding to bring advances to a marketable stage. Looking at examples in instrumentation development, software to assist in image acquisition and interpretation, and radiopharmaceutical advances all point to a much later stage in which industry assumes responsibility for the ultimate development of the product. In some cases, FDG for example, the utilization of the product had progressed so far that little if any intellectual property remained and thus patent protection was not available to protect the investment in commercializing the invention.
In light of this fact, it is regrettable that the primary driver of progress in our field in the United States has been funding from the Department of Energy (DOE) and its predecessor agencies. The Atomic Energy Act was clear about the need to develop peaceful uses of the atom, which remains the mission of DOE. And medical applications are one of the sterling examples of how that can be achieved. About six years ago, the Office of Management and Budget (OMB) pulled the funding for nuclear medicine research out of the Federal budget. It took four years to get that funding restored at a fraction of its original level. The president’s latest budget includes $5 million in funding for nuclear medicine research. In a way, those in the field are now seeing the impact of the combination of no funding for a time and then drastically reduced levels. The pipeline of new compounds has been reduced considerably. More importantly, the researchers who we need to continue to move the field forward did not enter nuclear medicine because of lack of funding and the subsequent withering of interest in the discipline.
The creation of the National Institute for Biomedical Imaging and Bioengineering (NIBIB) has not replaced the lost funding from DOE, even though there have been promises to that effect. The competition for resources with other imaging modalities and the bioengineering community is fierce with NIBIB and no relief is in sight. Moreover, the DOE had a focus on early stage basic and applied research that is not usually associated with the mission of NIH and its institutes. Without a significant foundation, it is hard to imagine how the field of nuclear medicine can continue to flourish.
That is a long preamble to a simple fact. Unless we educate the stakeholders in the Federal government to the benefits of molecular imaging and nuclear medicine, we will continue to see the demise of the field. When asked, please lend your support to this endeavor.
1. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Stender J, Gosseries O, Bruno M et al. Lancet Apr 16, 2014 early online publication.