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To infinity and beyond: Day trip to a RI science fest

The academic research biomedical enterprise is alive and prospering in Rhode Island

Image courtesy of Andrew Marshall presentation

A painting by Alexis Rockman, entitled, "The Farm," used to illustrate the keynote address by Andrew Marshall, editor of Nature Biotechnology, at the IDeA 2019 Rhode Island symposium.

Photo of image by Richard Asinof

A slide developed by Brown neuroscientist Chris Moore, shared at the IDeA symposium, detailing the potential value for translational research in neuroscience in Rhode Island.

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By Richard Asinof
Posted 6/10/19
The all-day symposium featuring the work of Rhode Island’s 11 Centers of Biomedical Research Excellence offered proof positive that the academic research enterprise in the state is alive, well and prospering.
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Attention by most political reporters will be focused on the R.I. State House this week, as the revised budget makes its way into daylight and, with it, some transparency will leak out about the deals that have been made behind closed doors about who gets what, how much and when. Another spotlight will shine on the upcoming vote by the R.I. Senate Judiciary Committee on a revised bill to protect the rights of women for health care, including abortion, codifying Roe v. Wade into Rhode Island law.
One of the most intriguing pieces of new legislation, which was approved the R.I. Senate, was a bill sponsored by Sen. Joshua Miller, chair of the Health and Human Services Committee, which would explore the creation of a pilot program to create “harm reduction centers” to help prevent drug overdose deaths.
The centers, often referred to as “safe injection facilities,” would be supervised facilities for drug users, staffed by health care professionals, who could help in cases of overdose and make treatment referrals.
“If we are truly going to rein in the drug overdose epidemic, we must recognize drug addiction as the health problem it is, rather than as merely a crime,” Miller said. “People who are addicted need help and protection from the most dangerous possibilities of addiction. Having a place where someone can save them from an overdose and where there are people offering them the resources they need for treatment is a much better alternative to people dying alone in their homes or their cars.”

PROVIDENCE – There was no barbed wire in front of the Warren Alpert Medical School at Brown University, no centurions in uniform guarding the entrance, no security checkpoints to check credentials and photo IDs of the nearly 300 scientists and researchers who had gathered to attend the 2019 Rhode Island NIH IDeA Symposium on Friday, June 7, where the breadth and depth of the academic research enterprise in Rhode Island was on full frontal display, with 56 posters, with more than a dozen presentations and free-wheeling conversations, including analyses of terabytes of shared scientific data.

Researchers from 11 different Centers of Biomedical Research Excellence, or COBREs, located here in Rhode Island and supported by more than $200 million in federal funds invested by the National Institutes of Health through its competitive Institutional Development Award program, or IDeA, presented their ongoing work at the cutting-edge of scientific inquiry and translational research.

It was a wonk’s dreamscape: a proverbial stroll on an early summer’s day through the cultivated gardens of inner space, exploring the next frontiers in biomedical research in Rhode Island. To infinity, and beyond – or, at least, a daytrip adventure to a science fest in Providence.

The launch into inner space exploration was framed by Andrew Marshall, editor of Nature Biotechnology, who gave the symposium’s keynote address, talking about the creation of new life forms as re-engineered biological circuits, which he said would serve as the future commodities of health care.

Control freaks at the crossroads

No one attending the symposium appeared to be distracted by President Trump’s Twitter claim that the moon orbiting the Earth was actually part of Mars. Free and open scientific inquiry is still encouraged here in Rhode Island, despite the recent efforts of White House officials to bar written testimony by a State Department intelligence agency warning that human-caused climate change was “possibly catastrophic.”

However, the open exchange of ideas at the symposium was occurring within the broader context of a messy corporate conflict over which health system – Care New England, Lifespan, or Partners Healthcare in Boston – would enter into a new “marriage” contract. The conflict has created a strong undertow running counter to the free flow of ideas.

Those negotiations had taken a sharp turn on Tuesday, June 4, when Gov. Gina Raimondo announced that she was going to play matchmaker in order to try and bring Brown, Care New England and Lifespan to the altar once again, to broker an arranged marriage. As a result, a two-year effort by Partners Healthcare in Boston to acquire Care New England was put on hold. [See link below to ConvergenceRI story, “Matchmaker, matchmaker, find me a find, catch me a catch.”]

Negotiations are now underway behind closed doors, with a titanium curtain having been erected to prevent the free flow of information – the veritable antithesis of open scientific inquiry. A private consulting firm, the Chartis Group, based in Chicago, Ill., is tasked with managing the negotiations, being paid a fee of $200,000 by the Rhode Island Foundation to do so.

And, much under-reported, the dean of Brown’s medical school, Dr. Jack Elias, is playing a pivotal role in Raimondo’s matchmaking efforts to forge the new entity.

The day before the symposium, a ConvergenceRI interview with Dean Elias, which had been scheduled for Monday, June 10, had been abruptly cancelled, without any clear reason given; it was an interview that had been in the works for more than four months.

So, it was with some trepidation that ConvergenceRI crossed the threshold of the med school on Friday morning, wondering if he would also be blocked from attending the symposium.

Thankfully, ConvergenceRI was welcomed warmly by a number of staffers that worked at Brown. [When he asked, jokingly, if he needed to submit his palm print for security verification, one staff member laughed and gave him a high-five.]

Of course, one of the very first people whom ConvergenceRI encountered in the coffee line was Dean Elias himself, who, while attempting to scuttle away from ConvergenceRI [hard to do when carrying a cup of coffee], made it clear that “radio silence” had been imposed as a result of the negotiations with the Governor.

ConvergenceRI persisted, following after Elias, much to the chagrin of the dean: Was there a good time to reschedule the interview for later in the summer?

Elias said no, in an exasperated tone of voice, because all his time would now be taken up trying to create a new academic medical enterprise in the next 30 days.

Still, ConvergenceRI persisted: What would prevent you from answering the questions, focused on Brown’s efforts around investments in translational research? [The questions had been shared in advance of the interview, by request of the Dean’s office, and had avoided asking about any sticky issues around the politics of merger and acquisition.]

Elias, ducking away, seeking the security of his reserved seat in the front row of the auditorium, dismissed the notion: “I didn’t like a number of the questions anyway.” So it goes.

All the news that fits
The good news was that the IdEA symposium embodied the best of Rhode Island’s rich research environment: an open, collaborative spirit, in which complex ideas were shared and discussed and challenged.

If only that same kind of ethos around transparency existed about the negotiations now underway between rival health systems and Brown.

In turn, ConvergenceRI was able to speak directly with both of the key organizers of the IDeA conference, Dr. Jim Padury and Ed Hawrot, Ph.D., along with a number of the featured speakers, all of whom welcomed conversations around investments in translational research.

Padbury is the William and Mary Oh/Willam and Elsa Zopfi Professor of Perinatal Research, Warren Alpert Medical School, Pediatrician-in-Chief and Chief of Neonatal/Perinatal Medicine, Women and Infants Hospital, and the program director and principal investigator of Advance-CTR.

Hawrot is the program coordinator for Advance-CTR, helping to leverage the resources available to translational researchers to help fuel collaborations and discoveries. Hawrot is the Alva O. Way University Professor of Medical Science, Senior Associate Dean of Biology, and Professor of Medical Science at Brown University.

Both had been interviewed at length by ConvergenceRI for previous stories [as had Elias].

Unintentionally, perhaps, the symposium presented clear and irrefutable evidence: any fears voiced about how a potential acquisition by Partners Healthcare of Care New England would somehow jeopardize the academic research enterprise in Rhode Island, and in particular, at Brown, were groundless. When asked, one principal investigator for a COBRE center responded with a terse, one-word answer to such fears: Bullshit.

The not-so-good news was that many attending and presenting at the symposium, representing the elite scientists engaged in the research enterprise in Rhode Island, voiced worries [off the record] about the viability of a locally run enterprise that would create one entity that would control 80 percent of all hospitals in Rhode Island, an effective monopoly.

Without a large infusion of capital, many concurred, there was simply not enough “money” to sustain and support the local hospital systems and the academic research enterprise.

The future of bioengineering
The keynote address for the symposium was delivered by Andrew Marshall, the chief editor of Nature Biotechnology, who attempted to fit his lengthy presentation into 35 minutes and failed.

Marshall admitted that it was his first trip ever to Rhode Island, and he described his interactions with Brown as a kind of revelation – how a college that has had a reputation of excellence in the arts and social sciences had begun thinking about translational research in biology.

“This is an idea that is very close to my heart,” Marshall said. “This idea of how do you take interesting ideas in the field of academia and apply them to medicine,” adding that “The world is struggling with this problem.”

Marshall articulated his vision of translational biomedical research: “Working out what are your most interesting ideas that come from your faculty that then can be translated into products that work in the world of medicine and actually change the lives of patients.”

It is an incredibly complex process, Marshall continued, going from the idea to product, with many, many stakeholders in the process. “You really have to spend a lot of time bringing all the different stakeholders in the pipeline, from the original idea to the patient and the patient group that benefits from the product.”

Marshall then displayed a painting by Alexis Rockman, entitled, “The Farm,” which he said captured the “unsettling” feeling about biological engineering. [See first image above.]

[The artist, Rockman, described his concept in creating the painting: “The Farm contextualizes the biotech industry's explosive advances in genetic engineering within the history of agriculture, breeding, and artificial selection in general.” In the painting, Rockman continued, “I am interested in how the present and the future look of things are influenced by a broad range of pressures – human consumption, aesthetics, domestication, and medical applications among them.”]

Biological engineering, Marshall argued, was very different from any other type of discipline, because “we are messing around with life, we’re changing life, and we’re making decisions about how we are going to create new types of organisms for a particular end.”

What the researchers said
Each of the presenters at the conference from the COBREs gave talks about their ongoing research, in impressive fashion:

Peter Belenky, Ph.D., from the COBRE Center for Antimicrobial Resistance and Therapeutic Discovery, gave a talk on “Linking microbial metabolism to antibiotic susceptibility in the microbiome,” which presented data evidence that probiotics administered in conjunction with doses of antibiotics may actually interfere with microbiome’s ability to rebalance itself.

Dr. Jody Rich, director of the COBRE Center on Opioids and Overdose, introduced the concept behind the new program and discussed the long-term nature of recovery. Then Kirsten Langdon, Ph.D., presented details on how “Digital health interventions to promote engagement in, and adherence to medication-assisted treatment.”

• Two researchers from the COBRE Center for Stem Cells and Aging, Dr. Lynae Brayboy, and Victoria Templer, Ph.D., gave fascinating talks. Brayboy discussed her efforts to explore the causes in the disruption of mitochondrial homeostasis in the oocyte and ovary; Templer discussed the cognitive effects of sociality as part of her longitudinal aging study.

Breakout sessions
During lunch, there were concurrent breakout sessions. ConvergenceRI attended the one led by URI Professor Judith Swift, the director of the Coastal Institute about talking science to lay people. She attempted to address the gap between scientists and the widespread lack of scientific literacy.

Two other breakout sessions featured discussions about how to incorporate evaluation into proposals for federal funding, led by Judy Kimberly, Ph.D., and an overview of the services offered by the Brown Center for Biomedical Informatics, led by Neil Sarkar, Ph.D., who is serving as the interim president and CEO of the Rhode Island Quality Institute.

Processing information
During the early afternoon sessions, in her talk, “Effect of transcranial direct current stimulation timing on safety memory in post-traumatic stress disorder,” Mascha van ‘t Wout, Ph.D., a researcher with the new COBRE Center for Neuromodulation, provided a clever way to weave her own personal story about her lifelong fear of dogs, after witnessing a brutal attack by a dog when she was a child, into her work on safety learning and the timing of neuromodulation to produce the best long-term results.

In turn, Dr. Adam Czynski, a researcher with the ECHO IDeA Pediatric Clinical Trials Network, presented his work on developing “Randomized Blinded Trial to Shorten Phamacologic Treatment of Newborns with Neonatal Withdrawal Syndrome [NOWS],” a compelling discussion of how to measure the outcomes two different treatment strategies of care for what has become an increasing trend: babies born with drug dependencies.

The takeaways
Many of the best discussions during the day, it seemed, occurred in the down time between talks, the random collisions occurring around the poster displays. But none of those would be recorded or streamed or preserved, except in the memories of the participants, in a kind of undocumented history.

And, to be honest, ConvergenceRI was worn down by the avalanche of “too much information.” At some point, the brain shuts down, even after numerous cups of coffee.

Composing a narrative about what had taken place at the symposium was going to be difficult, ConvergenceRI realized, because it existed in a kind of alternative world, a parallel galaxy, to the mindless chatter of political discussions.

ConvergenceRI began to write down some notes, so as not to forget some of what was said:

No other reporters had covered the symposium, because no other news outlet in Rhode Island had invested in covering the Innovation Beat. Why was that? ConvergenceRI thought about the haunting image of Brueghel’s “Landscape with the Fall of Icarus,” with a farmer and shepherd going about their business, and ships leaving the harbor, as Icarus plunged into the sea.

Money changes everything. The bottom line was that the research enterprise in Rhode Island, as demonstrated by the number of COBRE research centers, was alive and well and prospering. But, as many of the participants voiced in conversations with ConvergenceRI, there was not enough capital being generated by Lifespan or Care New England to sustain a unified health system, because the business model is unsustainable. The question was whether Brown is willing to step in and invest money from its endowment to finance a unified, locally run health system. How much, in the hundreds of millions, would it take? How much of that money would be at risk? Would it be based on the financial model that Yale New Haven deployed, given that Dean Elias came from the Yale Med School? Would Brown, in turn, move to consolidate its growing control of physician group practices under the umbrella of Brown Physicians, Inc.?

Even if the frontiers of biomedical research are expanding, human nature is still atavistic, captive of what some call the impulses of the dinosaur brain, eat or be eaten. Repeatedly, and often unsolicited, participants at the symposium voiced concerns that the biggest problem about the attempt to create an integrated, locally-run health system was the truculent nature of a hospital system’s leadership and efforts to control everything.

The role of the patient and the community, which have no seat at the table and no part in the decision-making around the future alignment of health systems. A tweet from the R.I. Department of Health, the same afternoon as the symposium, expressed the counter-argument: “In RI, we believe public health HAS to be community led to achieve the best outcomes. In #HealthEQuity Zones across RI, community members are leading the change they want to see in their neighborhoods.”

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