The pandemic has shifted the research landscape at academic medical institutions. What’s been the biggest change?
Science has been on the front page, and there’s been more focus on science. I’ve seen that in my interactions with patients, people in the community, even in my neighborhood. They’ve said, ‘Don’t you work out at the medical center?’ and ‘What is this RNA vaccine deal?’ I think it’s created a unique opportunity for us to show what science can do.
In some ways there’s been the expectation that science needs to deliver, that we need to take these fundamental discoveries – like those that support the development of the RNA vaccines – that can actually get through a process and get approved and get in your arm to help prevent serious illness. So, one big change I’ve seen is more community engagement on a broad level.
Researchers, too, see that our work is now in a different and special place in society. And so, in some ways, one of the things that I’ve certainly felt is a push to keep true to the research mission. How do we fulfill our mission of being a substantial, significant and accurate academic medical center to address the current need, to keep our research mission moving forward in relevant ways?
I’m an oncologist by training, so I see this time with a broad view in making sure we also continue to make advances in regard to cancer, diabetes, neurologic disorders and everything else. So, I think the question has been: How do we keep true to that broad research mission?
The pandemic has seen a shift to a more collaborative and global approach to research. Do you see that as a change for the better and, if so, what else has reshaped for the better?
I think it’s a great thing. There are a few things that happened. Researchers were working remotely and found it easier and more acceptable to share data. Part of that is, we’re all remote and there’s got to be something to look at or share, or park in a secure drive.
I think open science has made some substantial advances in how we think about this. Again, there is the pressure I referred to – we had to deliver. COVID is a real threat, and the question is: How do we collaborate together to solve it? In some ways, the traditional model of science has been: ‘I’m going to work in my area and develop this my way, and I’m going to publish my research and show what our group has done.’
You see that changing pretty rapidly. If you look at open science or data sharing or different ways of doing studies, we’ve been moving in that direction anyway. The pandemic clearly accelerated that. This is a good thing.
I’ll use this example. Let’s say I was interested in prostate cancer patients’ outcome from COVID, looking at whether they were doing worse than the general population because of their subset factor. If I had 100 patients in a study, I couldn’t tell too much. But if I collaborated with colleagues and got to 1,000 prostate cancer patients with that subset, that offers greater information and potential impact.
That’s the power of data sharing: You can aggregate information without disclosing any personal information in a way that is impactful. So, we can tell patients we’re protecting the privacy of their data and at the same time sharing it more broadly. I think that’s one of the paths we have to make sure to pursue, and I think it’s certainly possible.
Have there been any changes over the pandemic that have been for the worse related to research?
There has been the pressure to react, respond and have an impact on COVID. There have been some high-level retractions of research papers (at other institutions) related to COVID. If you look back at the normal editorial process, in some ways editors and researchers might have felt pressure to move forward more quickly than is usual.
But I think the general principle to take away is: Everybody agrees we need to make sure that we still have rigorous science, that we still have the peer-review process robustly looking at the research methods on the data we put out there. Again, I think there have been some key retractions of papers, which have been reported in the media, and those are probably an example of where the pendulum can go too far in emphasizing timeliness.
I think the FDA (U.S. Food and Drug Administration), for example, has done a good job of balancing the very robust processes we have to develop and approve drugs in an accelerated way – and still very cognizant of safety and efficacy issues. If you look at media reports, you have some groups saying, ‘We’re moving too fast,’ and others saying, ‘We’re moving too slow.’ And I think the drug approval is in the middle of that. And I honestly think they have done a good job of balancing these considerations to approve drugs in a manner that is representative of the important principles of science and safety.
Has the COVIDome project, which launched at CU Anschutz in November 2020, helped accelerate COVID research since its inception?
I think that is a good example of how you can respond to an emergency situation and also sort of change the paradigm. In March 2020 we were all saying, ‘How can we help? How can we respond to the pandemic?’ We started getting researcher requests, saying, ‘I would like these patient samples; I want to do this analysis.’ At the time, the hospitals had changed access to the clinical areas due to the pandemic. Then we had safety risk issues with PPE and other concerns, so we said, ‘Does it make sense to have 20 different groups trying to get the same sort of samples, from the same group of patients who are already hospitalized and were under medical pressure from their illness?’
We did something a little different. We decided to have one central process in which we’d collect the samples. We work very closely with our hospital partners, as well as the regulatory teams and IRB. Then we decided we were going to have a central effort to gather and then share the samples. In fact, it became clear as we did that to say, ‘Ten groups all want to do the same analysis. Is there a way we can do that analysis once – for efficiency – and then share it with the community?’
In fact, we thought, ‘What if we did that analysis once and then shared it with the world – just put it out there?’ Again, always ensuring that we were protecting participant privacy, being very careful about that aspect. It is a different approach. So rather than saying, ‘We as an institution are going to use this (data) for our research,’ we said, ‘That’s true, but let’s also share it broadly.’
If you look at the COVIDome statistics, people from around the world – dozens and dozens of countries now – have been able to access and identify data from our portal and start to make some connections in their evaluation of the data. You can look at specific proteins, genetics, metabolomics with respect to outcomes. You can look at different elements and start to put it together in a way that represents open science and how it can be beneficial.
One of our own spearheads of COVIDome, Joaquin Espinosa, PhD, refers to the open science approach as countercultural. Do you feel that is an apt description for this innovation?
Dr. Espinosa felt very strongly, and I did as well, that we should make COVIDome open to whoever could utilize it and make connections to it. And it is a little countercultural.
If we were sitting here 10 years ago, it would be extremely countercultural. It would be very avant-garde. Over time, in a variety of ways, we have tried to move in this direction. It makes sense; it’s the right thing to do. I would say we were moving in that direction, and the pandemic was an inflection point to accelerate doing the right thing for science. And this is a great example of our campus’s innovation and culture.
Has the pandemic led to new ways of measuring the impact of academic medical institutions and how their research translates to the general public?
The general public doesn’t care about many of the things we have focused on traditionally in terms of measuring our impact. Frankly, they want to know if we are working together to solve big and important problems. And, certainly, the pandemic has been a big and important problem.
They don’t want to hear us saying, ‘Well this is my data, and that’s your data.’ I understand the sentiment and agree with that. So, I think we’re not going to be judged by this research center, this particular clinical trial or whatever. Rather, we’ll be judged on how science and academic medicine is going to take on big problems. And I mean this in the broad sense of science: fundamental science, translational, clinical, community, informatics researchers – all of those disciplines. How can we utilize all of these approaches to come together to solve big problems?
The public is going to be more inclined to judge science as a whole rather than individual institutions. It’s up to us as research communities to work together to achieve those big things. I think it’s going to be a higher standard for us going forward, and I think that’s good.
There’s been much in the media about distrust around science. Has the pandemic contributed to a wave of misinformation and distrust in science, or has COVID provided a pivot to give scientists a platform on which to better demonstrate their value?
This is a difficult topic. I would say we exist in a polarized place right now. As citizens, as researchers, I think science can get caught up in those large waves that are going on. I think it’s really important for science to ride above all those waves. Science can help with that by delivering and being reliable and having good standards and, frankly, not having papers that need to be retracted. Our foundation always needs to be in scientific principles, strong processes to evaluate science, and robust ways to study and develop new drugs. Those have to be things that are trusted, and it simply has to be above all of the other polarity that we see.
I think the only way to get through the problem of distrust and misinformation is to be seen as crystal clear and focused on the established scientific principles and regulatory processes that provide us a sound foundation.
How is big data, which is becoming a major emphasis on our campus, changing the nature of research?
First, I’ll say academic research institutions have their own cultures. I think we’ve got a very good culture on our campus. We’re a place with an upward trajectory; we’re growing rapidly. Many of the large academic medical centers such as us have not been. They’ve plateaued in a steady state and have a long history. We’re different. We’ve more than doubled our faculty during my time as a part of this community. There are not many large academic medical centers in that place, and we’re in the top tier. So, part of our nature is that of growth. I don’t know if it’s the Western or Rocky Mountain spirit, but we also have a collaborative nature – we work together in a way that’s not typically seen at all academic medical centers.
We have six colleges and schools on our campus. We’re all here together, so we can intermingle across our different fields in ways that are really helpful.
I think in big data, which is really a big emphasis here, we have many key emerging great leaders who are doing great work. Big data has been a major driver of innovation during the COVID pandemic. Melissa Haendel, PhD, (chief research informatics officer), Tell Bennett, MD, MS, and others from our campus have been involved with something called N3C, which is a big data collaboration during COVID. And essentially, what we’ve mostly been talking about is science among scientists. As a researcher, I might have cell-culture data, and the question is ‘How do I share it?’ The other way to look at it is that there are huge datasets.
So, if you look at clinical research data – again, such as, ‘How do prostate cancer patients with COVID differ from others? How do we look at that?’ – one of the things Melissa, Tell and others have been able to do, through the N3C, is to say, ‘Well, rather than bringing together a couple academic medical centers, let’s try to get dozens of these centers together to aggregate these datasets, and then share them and have a huge resource.’
With this effort, you can look at the large things that are happening in the pandemic, but also at very specific niche groups of patients who might have had a very different response to the pandemic than the next group. So, these are things that are happening here with leaders from our campus.
The crisis of the pandemic essentially said, ‘This is critically important that we figure out how to share data in a way that protects patient privacy and allows researchers to do amazing work.’ It’s really heartening to see leaders from our campus take these national roles in showing ways that big data can be very impactful. Big data is one of the key ways in which we’ll be able to solve the big problems.
What role does inclusivity – in ensuring representative patient populations are represented in clinical trials and research – play in the research enterprise?
It’s critically important on many levels. In terms of an equity lens, in terms of making sure the discoveries are of a patient population that represents our communities and the world. So, making sure, for example, that the distribution of patients by race, ethnicity and other factors on the trials represents the broader world is really critical.
One key project that’s been ongoing in which our campus has been taking part is CO-CEAL – Colorado’s version of Community Engagement Alliance – Against COVID-19 Disparities, a research project aimed at identifying and eliminating health disparities.
This is led by Donald Nease, MD, Ron Sokol, MD, Montelle Tamez and others on our campus. It’s really a way of having our academic efforts connect through community engagement, specifically around the issues of COVID. This could be informational, and it could be helping investigators – making sure they’re having a representative group of patients on their trials. We’ve been working on the issue of inclusivity in trials for a long time, and this need has been highlighted and emphasized during COVID.
We’re one of the national sites for the larger CEAL effort (operated by the National Institutes of Health). It speaks to how we have a long tradition at CU Anschutz of inclusivity in our research, as evidenced by the Colorado Clinical and Translational Sciences Institute and other entities rooted in community engagement, which clearly makes research better. It makes it more pertinent, makes it connect to the community. When community members are represented and part of the process, there is just a natural connection to results and having a feeling of ownership and involvement.
Do you have any final thoughts on the topic of the changing research landscape and what it means for science?
The public has been in the front row watching science try to solve a difficult problem during the COVID pandemic, and I think we need to take advantage of that opportunity. We need to show what science can do, how science should work, and how science can have an impact. We as scientists and academic medical centers are going to be judged on how we can address big problems together.
And for us to be successful in the eyes of the public and on our larger goals, we’re going to have to work together better than we have in the past. That is probably the grand challenge for us in the decade or two ahead.
