>> I'M WALTER KOROSHETZ,
AND IT'S A PLEASURE TO
WELCOME MY FELLOW DIRECTORS IN
THE PAIN SPACE WITH YOU AT THE
AGENCY COORDINATING MEETING AND
THIS IS OUR FIRST OF 2
IPRCC MEETINGS FOR 2022 THAT
HAVE BEEN PLANNED.
THIS 1 IS A PART DAY, THE FULL
DAY IS SCHEDULED FOR
OCTOBER 18th, SO IF YOU COULD
PUT THAT HOLD ON YOUR CALENDAR,
THAT WOULD BE GREAT.
OCTOBER 18th.
AS YOU KNOW THE PROCESS OF
GETTING NEW MEMBERS ON TO THE
IPRCC, IS NOT SIMPLE, IT GOES
THROUGH HHS, SO WHAT WE--WHILE
WE ARE WAITING FOR THE APPROVAL
OF 6 NEW POTENTIAL INCOMING
NOMINEES THEY HAVE BE APPROVED
BY HHS, WE HAVE INVITED IRMA
RODRIGUEZ, CHRISTINE SANG AND
BETH, TO SERVE ADDITIONAL TIME
ON THE COMMITTEE UNTIL THESE NEW
FOLKS COME ON SO I REALLY WANT
TO THANK THEM FOR TAKING US UP
ON THAT OFFER.
EACH OF YOU HAS BEEN SO HELPFUL
OVER THE PAST YEARS AND WE
REALLY VALUE YOUR INPUT,
CERTAINLY TODAY'S MEETING AND
POTENTIALLY EVEN OCTOBER
MEETING, WE WILL SEE.
AND I WANT TO SAY
CONGRATULATIONS TO THOSE WHO ARE
AT THE LAST MEETING, ARE NOW
MADE OFFICIAL.
SO THAT'S TODD [INDISCERNIBLE]
WHO LEADS THE PHARMACOLOGY
DEPARTMENT FOR THE PAIN AND
ADDICTION AT UNIVERSITY OF
ARIZONA, [INDISCERNIBLE] FOR
NATIONAL PAIN MANAGEMENT AT THE
VA AND MAGGIE BUCKLEY WHO IS ON
THE BOARD AND VOLUNTEERS FOR THE
[INDISCERNIBLE] SOCIETY AND
JULIE ELLER WHO SERVES WITH THE
ARTHRITIS FOUNDATION.
THERE'S 1 OTHER LYNN
[INDISCERNIBLE] UNFORTUNATELY
SHE HAD TO WITHDRAW HER
NOMINATION AT THIS POINT BECAUSE
SHE HAD TO DEVOTE ALL HER TIME
TO THE ROLE OF PRESIDENT OF THE
NATIONAL FIBROMYALGIA
ASSOCIATION AND THE UPCOMING
LAUNCH OF HER DIGITAL HEALTH
COMPANY CALL PAIN TOOLS BUT WE
HOPE TO HAVE HER JOIN IN THE
FUTURE.
SO THOSE ARE KIND OF INTRO
REMARKS AND I WONDERED NOW WHEN
THERE WOULD BE A GOOD TIME TO GO
AROUND AND HAVE PEOPLE INTRODUCE
THEMSELVES AND IS SAY A WORD
ABOUT THEIR BACKGROUND.
SNB ABSOLUTELY.
I WILL GO ACROSS THE SCREEN AND
I SEE IT SO BETH YOU WOULD BE
FIRST UP.
>> HI, EVERYONE I'M BETH
DARNALL, WITH STABBED FORD
UNIVERSITY, I DIRECT THE PAIN
RELIEF LAB, MY AREAS OF
EXPERTISE ARE CONDUCTING LARGE
RANDOMIZED TRIALS FOR
BEHAVIORIAL INTERVENTIONS AND
ALSO PREVENTION OPIOID TAPERING.
>> THANK YOU BETH, AND THEN WE
HAVE HELENE, LANG EVIN, WITH
PAIN AND PAIN MANAGEMENT WITH
NONPHARMAICOLOGICAL PAIN
APPROACHES.
>> AND MAGGIE YOU'VE BEEN
BRIEFLY IN THE NEWS, WOULD YOU
LIKE TO ADD ANYTHING?
>> I'M A BOARD CERTIFIED PATIENT
ADVOCATE AND I WORK WITH AS
WALTER SAID THE [INDISCERNIBLE]
SOCIETY AND PAIN
COMMUNITY.ORGAND WITH SOME OF
YOU OVER THE YEARS AND WE, THE
PAIN COMMUNITY IS THE FISCAL
SPONSOR FOR THE ALLIANCE TO
ADVANCE COMPREHENSIVE
INTEGRATIVE PAIN MANAGEMENT,
WHICH SOME OF YOU ARE ON THE
ADVISORY COMMITTEE FOR THAT
PROJECT AS WELL.
>> THANKS, MAGGIE, DAVE
WILLIAMS?
>> HI, GOOD AFTERNOON, I'M DAVE
WILLIAMS, ASSOCIATE DIRECTOR OF
THE CHRONIC PAIN AND FATIGUE
RESEARCH CENTER AT THE
UNIVERSITY OF MICHIGAN AND I
HAVE A BACKGROUND IN PATIENT
REPORTED OUTCOMES AND INSTRUMENT
VALIDATION AS WELL AS DIGITAL
HEALTH INTERVENTIONS FOR CHRONIC
HEALTH ILLNESSES, THANK YOU
DAVE.
JULIE WOULD YOU LIKE TO ADD TO
YOUR BRIEF INTRODUCTION.
>> SURE, HI, EVERYBODY MY NAME
IS JULIE ELLEXER ER, I'M
STUDYING AT HARVARD FOR MY
MASTERS IN PATIENT HEALTH AND MY
BACKGROUND IN ON PATIENT
ADVOCACY AND I'M REALLY GLAD TO
BE A PART OF THE TEAM.
THANKS.
>> THANK YOU, ELIZABETH KATO,
ANOTHER 1 OF OUR FEDERAL
MEMBERS,.
>> I'M ELIZABETH KATO, MEDICAL
OFFICER AT THE AMERICAN HEALTH
CENTER FOR RESEARCH AND QUALITY,
I WORK WITH THE EVIDENT BASED
PRACTICE CENTER PROGRAM AND ALSO
DIVISION OF PRACTICE IMPROVEMENT
HERE.
>> THANKS ELIZABETH AND TODD 1
OF OUR NEWEL MADE OFFICIALS.
WOULD YOU LIKE TO ADD, TODD?
>> SURE, MY BACKGROUND IS IN THE
AREA OF PRECLINICAL RESEARCH
ESPECIALLY IN AREAS OF CHRONIC
PAIN, NEUROPATHIC AND METASTATIC
CANCER PAIN.
>> THANKS TODD, AND JIM, YOUR
NEXT UP.
ONE OF OUR SENIOR MEMBERS AT
THIS POINT.
>> GOOD DAY, EVERYONE I'M JIM
BROA TCH, AND WE ARE SERVING THE
RPUNISH SD.
>> CHRISTINE GOERTZ.
>> HELLO EVERYONE, I'M A
PROFESSOR AND VICE CHAIR OF
IMPLEMENTATION OF SPINE HEALTH
INNOVATIONS IN THE DEPARTMENT OF
ORTHOPEDIC SURGERY AT DUKE
UNIVERSITY SCHOOL OF MEDICINE
I'M ALSO SHARE PERSON OF THE
BOARD OF GOVERNORS OF THE
PATIENT-CENTERED OUTCOME
INSTITUTE WITH PC ORI, MY
RESEARCH INTERESTS ARE PRIMARILY
FOCUSED ON LARGE PRAGMATIC
CLINICAL TRIALS OF
NONPHARMACOLOGICAL APPROACHES
FOR PAIN MANAGEMENT.
>> THANK YOU CHRISTINE.
SUE PINKHAM,.
>> HI, I'M SUE, WE WORK WITH
CHILDREN WHO LIVE WITH SEVERE
CHRONIC PAIN.
>> [INDISCERNIBLE] RODRIGUEZ,.
>> HI, GLAD TO BE HERE WITH YOU
AND MY BACKGROUND AND SERVING AS
THE CHAIR OF THE INTERSTITIAL
CYSTITIS ORGANIZATION, BEEN A
BOARD MEMBER FOR A NUMBER NUMBER
OF YEARS TRYING TO HELP DEAL
WITH THAT HORRIBLE PAIN.
THANK YOU.
>> FOR THANK YOU FOR AGREEING TO
STAY WITH US PAST YOUR TERM, WE
APPRECIATE THAT.
>> RICO, 1 OF OUR MEMBERS?
WE DON'T HEAR YOU.
DRNCHL.
>> I'M RICO [INDISCERNIBLE] I'M
DIVISION DIRECTOR AT THE
DIVISION OF ANESTHESIOLOGY
ADDICTION AND PAIN MEDICINE IN
THE OFFICE OF NEUROSCIENCE AND
THE OFFICE OF NEW DRUGS AT THE
FDA.
>> THANK YOU.
AND CHRISTINE SONG.
>> HI, I'M A PEDIATRIC ADULT
ANESTHESIAIOLOGYST AT BRIGHAM
WOMEN'S HOSPITAL INON WHERE YOU
DRIVE THE PAIN PROGRAM, OUR
FOCUS IS ON THE DESIGN OF
INFOIVATIVE TRIAL STRATEGIES TO
ACCELERATE THE CLINICAL NOVEL
ANALGESICS AND A REFRACTORY OF
PAIN SYMPTOMS.
>> THANK YOU FOR EXTENDING YOUR
TERM.
DAN CARR IS A RETURNING RETIRING
MEMBER AND HELPING US WITH OUR
MEETING TODAY.
DAN?
>> THANK YOU IT'S A PLEASURE TO
BE HERE, MY INVOLVEMENT DATES
BACK SEVERAL DECADES DURING
WHICH TIME I'VE BEEN INVOLVED IN
CLINICAL, PRECLINICAL AND
REGULATORY ASPECTS OF PAIN
ASSESSMENT AND TREATMENT.
>> THANKS, DAN.
THAT IS EVERYONE I SEE ON THE
SCREEN AND I DON'T SEE ANY
TELEPHONE NUMBERS, ON SO I'M
ASSUMES WE CAUGHT EVERYBODY
WHO'S HERE, IF SOMEONE JOINS
LATE, WE CAN POP IN WITH ANOTHER
INTRODUCTION AT A LATER TIME.
AND SO WALTER BACK TO YOU IF YOU
WOULD LIKE TO PROVIDE ANY
HIGHLIGHTS ON YOUR BUSY WEEK
LAST WEEK OR OTHER THINGS
RELATED TO PAIN?
>> WELL, YEAH, I WOULD JUST SAY
THAT LINDA KNOWS REALLY WELL
THAT THE HEAL INITIATIVE HAS
GIVEN US THE OPPORTUNITY TO
TRANSFORM PAIN RESEARCH GOING
INTO THE FUTURE, THE FUNDING FOR
THE HEAL INITIATIVE COMES TO THE
BASE BUDGET OF THE NIH, SO IT'S
NOT SOMETHING THAT WE SUSPECT
WILL DISAPPEAR MPLET WE HAVE,
YOU KNOW A NUMBER OF INSTITUTES
THAT SIT AROUND THE TABLE AND
ARE WORKING CLOSER TOGETHER THAN
EVER BEFORE, THANKS GREATLY TO
THE LEADERSHIP FROM DR. LANG
EVINE, WHO IS ON TODAY, BUT A
NUMBER OF THE OTHER INSTITUTES
AS WELL HAVE BEEN INCREDIBLY
ACTIVE AND PARTICULARLY SOME OF
THE NEWER IC DIRECTORS RENA,
D'SOUZA, WITH THE CRANIOFACIAL
RESEARCH, AND LINDSAY FROM THE
NATIONAL INSTITUTE OF AND MORE
ACTIVE AND NCATS IS VERY ACTIVE
IN DEVELOPING NEW THERAPIES,
THERE'S THE APP BETWEEN DRUG
ABUSE AND PAIN AND ACTUALLY 1 OF
THE BIG PROJECTS THAT ARE BEING
IS HAVING TO TREAT PAIN AND
PEOPLE WHO ARE ALSO ABUSE
OPIOIDS, SOMETHING THAT, YOU
KNOW I THINK IS 1 OF THE HARDEST
GROUP OF PEOPLE TO TAKE CARE OF
BUT CERTAINLY A LOT OF DOCTORS
WON'T EVEN DO IT, IT'S
DIFFICULT, A REAL CHALLENGE
THERE WHICH BRINGS US TOGETHER
WITH THE DRUG ABUSE INSTITUTES
IN A WAY WE'VE NEVER BEEN
BEFORE.
AND MAYBE HELENE, CAN TALK ABOUT
OR REJOIN TO GIVE THEM SOMETHING
THAT IS NOT FLEETING 3 THOUGHT
ABOUT BUT IT WENT OUT OF MY HEAD
AS SOON AS IT WENT IN AND IT WAS
SO IMPORTANT AND I FEEL BAD I
MISSED IT BUT HELENE GRABBED ON
TO THIS, BUT DO YOU WANT TO
MENTION ABOUT REJOIN?
>> SURE SO REJOIN IS AN
OUTGROWTH OF A PROGRAM THAT CAN
ACTUALLY ARE IN THE MISDZ OF
LAUNCHING MY O FACIAL PAIN AND
WE'VE TALKED ABOUT MY O FACIAL
PAIN AT OUR PREVIOUS
IPRCC MEETINGS AND THE IDEA IS
THAT WE HAVE A BIT OF A GAP IN
KNOWLEDGE RIGHT, ABOUT AND
FASCIA AS PAIN GENERATED
RETIREDDORS AND WE ARE IN THE
MIDDLE OF CATCHING UP ON THAT
WHICH WE HAVE NOW, WE'VE HAD A
REQUEST FOR APPLICATIONS AND
WE'RE CURRENTLY REVIEWING
APPLICATIONS FOR IDENTIFYING
ABNORMALITIES TO MY O FACIAL
TISSUES AND MAY LEAD TO PAIN BUT
IMPORTANTLY AS WALTER WAS
MENTIONING IN THE JOINT, WHEN WE
THINK ABOUT SOMEBODY WHO HAS
PAIN, WE TYPICALLY THINK ABOUT
THE ACTUAL ARTICULATION ITSELF,
THE CARTILAGE AND THE SIN OVIUM
AND THERE'S A LOT OF OTHER
TISSUES AROUND THE KNEES,
INCLUDING THE JOINT CAPSULE AND
THE MUSCLES AND THE FASCIA AND
THE LIGAMENTS, ALL OF THAT,
SOMEBODY HAS PAIN IN THEIR KNEE,
WE DON'T KNOW IF THE PAIN IS
COMING FROM INSIDE THE JOINT,
CARTILAGE OR COULD BE FROM THESE
OTHER TISSUES.
AND AND ALSO THERE MAY BE
TISSUE, STIFFENING OF THE FASCIA
OR WEAKNESS OF THE MUSCLE THAT
MAY CAUSE THE GENERATION AND
PAIN IN THE KNEE ARTICULATION
ITSELF SO THIS THEIR INTERPLACE,
THEIR INNOVATION, THEIR BLOOD
SUPPLY, ALL OF THAT, SO WHAT
REJOIN WANTS TO DO IS LOOK AT
THE VERY BASIC UNDERLYING
INNERVATION OF THESE VARIOUS
TISSUES AND UNDERSTAND HOW THE
SENSORY INNOVATION, AND NERVES
ARE PRESENT WITHIN ALL OF THESE
TISSUES WHICH SO FAR HAS NOT
BEEN SYSTEMATICALLY MAP THE
INNERVATION AND THEN TO LOOK AT
HOW THIS INNERVATION IS ALTERED
IN THE PRESENCE OF AGING FOR
EXAMPLE, PATHOLOGY,
DEGENERATION, ET CETERA AND HOW
IF THERE MAY BE REVERSIBLE
ABNORMALITIES AND WE KNOW THAT
SENSORY NERVES GO OUT SOME
SPROUT AND CARTILAGE, AND WE
DON'T KNOW WHAT CAN PREVEBT IT
OR REVERSE IT, SO THAT'S WHAT
REJOIN IS ABOUT, SO WE'RE
EXCITED ABOUT THIS NEW PROGRAM.
>> ONE OF THE MAIN JOINTS OF
INTEREST IS THE TEMPORAL
MANDIBULAR JOINT.
I SEE JENNIFER IS HERE FROM
NIDCR, AND AND CERTAINLY THAT
INSTITUTE HAS ALWAYS BEEN VERY
STRONGLY PUSHING PAIN RESEARCH
AND SO I JUST TALKED TO RENA
THIS MORNING ABOUT SOME OF HER
NEW IDEAS SO, YEAH, HEAL HAS
REALLY BROUGHT US TOGETHER.
>> I THINK IT'S SO IMPORTANT.
I MEAN UNFORTUNATELY MAIN IS A
MAJOR DRIVE TO BRING EVEN TO GET
PEOPLE TO DENTAL CARE AND FOR
PEOPLE WHO DON'T HAVE REGULAR
PREVENTION, JUST THOSE
PREVENTIBLE DISEASES LIKE
CAVITIES AND GUM DISEASE ARE
MAJOR PAIN DRIVERS BUT ALSO
CHRONIC PAIN LIKE WHAT HAPPENS
IN THE TMJ, WHICH WE WILL LEARN
ABOUT THROUGH REJOIN BUT ALSO
ORAL CANCERS AND OTHER ORAL
MUCOSAL DISEASES SO PAIN IS A
HUGE THING FOR DENTISTRY, AND SO
WE ARE WILLING TO WORK WITH YOU
GUYS COLLABORATIVELY TO TRY TO
MAKE A DIFFERENCE.
THANKS GENERATED FER AND I KNOW
THAT THE TOPIC TODAY 1 OF THE
MAIN TOPICS FOR THE DISCUSSION
TODAY IS GOING TO BE, YOU KNOW
HOW DO WE DEVELOP THE RIGHT
WORKFORCE TO DRIVE THE RESEARCH
FORWARD, PARTICULARLY IN THE
SPACE OF THE CLINICAL RESEARCHES
AND SO WE WILL BE TALKING ABOUT
THAT TODAY AND I'M SURE WHEN YOU
TALK ABOUT IT, YOU WILL BE
THINKING, WELL, IS THE NIH
REALLY GOING TO DO ANYTHING,
WELL THE ANSWER'S YES, WE WILL
DO SOMETHING, BUT, I JUST WANTED
TO READ THIS FROM AN RFA, THE
RFA IS EMERGENCY AWARDS, HEAL
INITIATIVE COORDINATING CENTER
FOR NATIONAL PAIN SCIENTISTS
CAREER DEVELOPMENT, SO THIS IS
AN RFA THAT'S CURRENTLY ON THE
STREET.
I THINK--OPEN DATA IS
JUNE 15th, YEAH, EARLY
SUBMISSION DATE, JUNE 15th,
THIS IS WHAT THE RFA SAYS, IT
SAYS, THE INTERAGENCY PAIN
RESEARCH COORDINATING COMMITTEE
HAS IDENTIFIED THE WORKFORCE
PROBLEM AS A BARRIER FOR NEW
PAIN RESEARCH AND HAS IDENTIFIED
FACTORS THAT CONTRIBUTE TO IT,
BE INCLUDING CHALLENGING
ENVIRONMENTS FOR CLINICIANS TO
PRACTICE RESEARCH AND A HIGH
DEPARTURE RATE AMONG SENIOR
INVESTIGATORS AND MENTORS.
THE IPRCC HAS ALSO IDENTIFIED A
NEED FOR MORE STRUCTURED
OPPORTUNITIES FOR EARLY STAGE
INVESTIGATORS, TO LEARN FROM
EXPERIENCE INVESTIGATORS.
SO THERE YOU GO.
THE IPRCC MADE IT INTO THE RFA,
BUT YOU KNOW THE RFA IS BECAUSE,
YOU KNOW WHAT WE HEARD FROM YOU.
SO WE WILL BE ALL EARS FOR THE
NEXT HOUR OR SO AS WE TALK ABOUT
THIS ISSUE AND SO THIS IS A
CENTER THAT CAN REACH OUT OVER
THE COUNTRY AND AS I UNDERSTAND
JUST COORDINATE ANY PAIN
RESEARCHER COMING FROM ANY
DIFFERENT INSTITUTE OR NIH
INSTITUTE OR MEDICAL INSTITUTE
AND TRY AND HELP DEVELOP THEIR
CAREERS.
NOW LINDA I KNOW THERE ARE OTHER
THINGS COOKING BUT I CAN'T
REMEMBER WHAT'S PUBLIC AND
WHAT'S NOT PUBLIC.
SO THE CENTER OF EXCELLENCE,
THAT SHOULD BE PUBLIC, RIGHT?
>> THAT'S PUBLIC, THE
COORDINATED CARE CONCEPT IS
PUBLIC AND THAT IS THE CONCEPT
THAT WOULD CALL FOR
INVESTIGATIONS IN HEALTHCARE
SYSTEMS WHERE WE COULD EMBED
EFFECTIVE CARE IN A WAY THAT
INCORPORATES PRIMARY CARE AS
SORT OF THE CENTER OF FOCUS AND
INTEGRATES PRIMARY CARE WITH
OTHER DISCIPLINE SPECIALTY
CENTERS WITHIN THE HEALTHCARE
SYSTEM, IT'S MOVING INTO
IMPLEMENTATION SCIENCE IN THAT
PARTICULAR 1.
AND WE HOPE THAT THAT WILL BE OF
GREAT INTEREST TO THE COMMUNITY
BECAUSE IT'S A FAIRLY COMPLEX
PROJECT TO GET STARTED WE HAVE
RPGHTS THAT JUST CLOSED OUT SO
WE HAVE INTERESTING WORK COMES
FORWARD FOR HEALTH DISPARITIES
WITH PAIN CARE WITH FOLK WHO IS
HAVE CHRONIC PAIN AND THEN
ANOTHER 1 WHO HAD FOLKS--FOR
FOLK WHO IS HAVE CHRONIC PAIN
AND OTHER CHRONIC CONDITIONS
SUCH AS O. U. D., OTHER CHRONIC
CONDITIONS AS WELL.
THERE'S A GREAT HUGE NUMBER OF
EFFORTS THAT BE COMING OUT ON
THE PRECLINICAL SIDE FOR
RESEARCH, IN THE PAIN ARENA AS
WELL, SO I THINK WE'LL ASK FOR
THOSE THAT ARE A LOT OF HEAL 1S
BUT THERE ARE STILL MANY THERE
WITHIN THE INDIVIDUAL
INSTITUTES, ACROSS NIH.
>> AND WE HAVE A SPECIAL PROGRAM
FOR ADMINISTRATIVE SUM ELEMENTS
TO SUPPORT CAREER ENHANCEMENT
RELATED TO CLINICAL RESEARCH AND
PAIN, SO PEOPLE WHO ARE RUNNING,
HEAL RELATED PROGRAMS CAN BUT IN
FOR THOSE TO SUPPORT YOUNG
TRAINEES, AND THE CENTER OF
EXCELLENCE IDEA, WAS CENTER OF
EXCELLENCE AND PAIN WHICH BRINGS
TOGETHER THE CLINICIANS AND THE
PRECLINICAL PEOPLE TOGETHER TO
ADVANCE RESEARCH SO, THERE WERE
A COUPLE THINGS WE HAVE ON THE
DOCKET AND TD DRIVER IS HOW DO
WE DEVELOP A STRONGER CADRE OF
CLINICAL RESEARCHERS IN THE
SPACE, AND IT'S MULTIPLE
DISCIPLINARY NEED, CLEARLY
MULTIPLE DISCIPLINARY NEED AND
GOOD EXAMPLE, WE DO LISTEN TO
THE IPRCC, AND THAT'S VERY
IMPORTANT TO GET THAT INPUT.
BECAUSE IN THIS HEAL DRIVE, IT
WILL HELP US WITH WHAT WE DO
NEXT.
>> WALTER, BETH PUT IN A
QUESTION ABOUT FOR POTENTIALLY
PICKING UP INVESTIGATOR
INITIATED RESEARCH AND LET'S
SEE, RATHER THAN THE LARGE
PROJECTS AND DO YOU WANT TO
COMMENT IN HEAL ABOUT THIS
PARTICULAR QUESTION?
THERE'S A BIT OF BACK AND FORTH
ABOUT--WE UNDERSTAND THAT FOR
INVESTIGATORS IT'S SPHIEMS
ESPECIALLY WHEN THERE ARE SHORT
DEDICATED TO LINES FOR A FUNDING
OPPORTUNITIES THAT DOANTD HAVE
SUPPORT FOR THE GRANT
APPLICATIONS, IT'S HARD TO HAVE
COMPLEX ORDERS FOR THE GRANT
APPLICATIONS THAT ARE DEPENDING
ON A COORDINATING CENTER AS
YOU'RE SAYING AND IT'S EASIER
PIRHAPPENS HAPPEN--PERHAPS TO TO
WRITE THESE ALONG THE LINE OR
RESEARCH PROJECT GRANTS FOR
EXAMPLE AND WE'RE CERTAINLY
THINKING ABOUT THAT A GREAT
DEAL.
YOU KNOW FOR EXAMPLE, THE MY O
FACIAL PAIN INITIATIVE THAT I
JUST MENTIONED, WE HAVE TRIED TO
REALLY SIMPLIFY FOR EXAMPLE,
WE'VE ADOPTED A FORMAT CALLED
R33--R60/R33 EXCUSE ME, WHERE
THESE ARE PHASED AWARDS WHERE
THE INITIAL PART IS LIKE A
PLANNING PHASE AND THEN IF YOU
MEET MILESTONES YOU CAN GET 3
MORE YEARS OF FUNDING.
THOSE GRANTS ARE NOT DEPENDENT
ON A COMPLICATED COORDINATING
CENTER, THEY'RE RELATIVELY NOT
TOO DIFFICULT TO PUT TOGETHER,
YOU JUST REALLY HAVE TO PAY
ATTENTION TO THE MILESTONE,
THAT'S THE MAIN ADDITIONAL
CRITERIA FOR TRANSITION, BUT
WHAT IT ALLOWS PEOPLE TO DO IS
TO DO SOME EXPLORATORY WORK WITH
THE FIRST 2 YEARS AND DO THINGS
THAT MAYBE A BIT MORE HIGH RISK.
AND SO THERE'S A LOT OF BACK AND
FORTH ABOUT, YOU KNOW WE WANT TO
MAKE SURE WE ALSO MAXIMIZE THE
INPUT THAT COMES OUT OF THE
FUNDING FROM THE INITIATIVE.
I THINK IT'S REALLY IMPORTANT
AND FOR THAT REASON FOR EXAMPLE,
THE PRISM PROGRAM, WE ARE VERY
MUCH RELYING ON THE HELP THAT
COMES FROM THE COORDINATING
CENTER THAT IS ALREADY EXISTS AS
PART OF THE HEALTHCARE SYSTEMS
RESEARCH COLLABRATORY WHICH IS
NOW CALLED THE PRAGMATIC TRIALS
COLLABRATORY AND SOME OF THE
PRISM GRANTS, THE PRISM GRANTS
THAT ARE PAIN RELATED HAVE
ALREADY SORT OF GRAFTED ON TO
THE PROGRAM AND ACTUALLY
DR. GERTZ IS HERE, SHE CAN TALK
ABOUT WHETHER IT'S BEEN HELPFUL
TO THEM OR NOT, AND WE THINK
THAT ACTUALLY HELPS AND THE GOOD
NEWS IS THAT A LOT OF THESE
TYPES OF GRANTS ARE ACTUALLY
SUCCESSFULLY TRANSITIONING AND
WE THINK THAT'S BECAUSE OF THE
HEALTH WE'RE GETTING FOR THE
ACCORD FLAITING RESEARCHER SO
THEY'RE MORE COMPLEX BUT AT THE
SAME TIME, THERE'S AN
ADDITIONAL--THERE'S A BENEFIT
FROM BEING PART OF THESE LARGER
STRUCTURES.
I DON'T KNOW IF I ANSWERED IT,
DID IT HELP?
>> ANOTHER EXAMPLE OF THAT
HELENE IS THE MORE INVESTIGATOR
DRIVEN 1S EVEN THOSE THESE ARE
TARGETED, THE HEALTH EQUITIES
ARE ALL SEPARATE APPLICATIONS OR
STAND ALONE AWARDS FOR AN
INDIVIDUAL TEAM AND SO THEY--THE
THEME IS TOPICALLY DRIVEN BY THE
RFA, BUT THEY'RE PHASED AWARDS
AND THEY'RE DONE WITHINAIN
INSTITUTION OR [INDISCERNIBLE]
TOGETHER.
>> DAVE HAS A QUESTION, DAVE
WILLIAMS?
>> THANKS, WALTER WHEN YOU WERE
DESCRIBING WHAT THE ISSUE WAS, I
BELIEVE I HEARD YOU SAY
SOMETHING ABOUT 1 OF THE
PROBLEMS WAS THAT PEOPLE WERE
EXITING THE FIELD OR MORE SENIOR
PEOPLE WERE EXITING THE FIELD
AND LEAVING KIND OF A VOID FOR
TRAINING NEW PEOPLE CAN YOU SAY
A BIT MORE ABOUT THAT OR--AND
RELATED TO THAT, HAS THERE BEEN
CONSIDERATION OF REVIVING THE
OLD KIND OF SENIOR CARE AWARD.
>> OKAY, SO IT'S ALL ANECDOTAL
BUT I GUESS WHEN WE TALK TO THE
MAJOR PEOPLE IN PAIN RESEARCH,
MANY OF THEM ARE TALKING ABOUT
RETIRING AND O--AND THEY'RE
CONCERNED THAT YOU KNOW, GIVEN
THE GAPS THAT OCCURRED, THE NEW
PEOPLE MAY NOT HAVE THE SAME
ESTABLISHED MENTORS AS THESE
FOLKS RETIRE SO I DON'T THINK
IT'S A MATTER OF FUNDING, IT'S A
MATTER OF JUST TIME GOING BY,
BUT I HAVE--I GUESS IN THE
MIGRAINE FIELD IS WHERE I HEARD
IT THE MOST.
I'M NOT SURE ABOUT AS MUCH IN
THE OTHER PAIN FIELDS BUT I
ASSUME IT WAS PRETTY MUCH
SIMILAR.
DAN, YOU'VE BEEN AROUND LONGER
THAN ME, DO YOU RESONATE WITH
THIS PROBLEM.
>> ABSOLUTELY, I DO BUT I WOULD
ALSO CAUTION THAT I THINK THERE
ARE SUBPOPULATIONS OF
INVESTIGATORS ACCORDING TO WATHE
TOPIC IS SO FOR ACUTE
PERIOPERATIVE PAIN, IS THIS IS
PROCEEDING QUITE VIGOROUSLY
ESPECIALLY AS THE TREATMENT OF
CHRONIC PAIN BECOME CLEARER AND
CLEARER SO THAT SEEMS TO BE
DOING WELL ROBUSTLY, I WOULD
SECOND, ALTHOUGH I'M NOT AN
EXPERT IN MY GRAIN, I CAN SEE
THAT AS A CONCERN, I ALSO THINK
THAT THE 800-POUND GORILLA IN
THE ROOM IS THAT THE OPIOID
CRISIS CONTINUES TO WORSEN AND I
THINK NUANCES THAT WOULD BE BEST
STUDIED BY DEDICATED LONG-TERM
INVESTIGATORS ARE NOT BEING
STUDIED BECAUSE OF STIGMA IN THE
FIELD, A FOCUS ON THE NONOPIOIDS
[INDISCERNIBLE] SO MY BOTTOM
LINE IS, IT DEPENDS UPON WHICH
PECULIAR --PARTICULAR TYPE OF IS
MOST IMPORTANT.
>> THE BASIC SIDE IS JUST
EXPLODING.
>> YEP.
>> WE WILL COME BACK MORE TO THE
[INDISCERNIBLE] CONVERSATION IN
A LITTLE BIT LATER ON THIS
AFTERNOON.
SO WOULD IT BE OKAY IF WE SWITCH
OVER NOW TO OUR BUSINESS ITEMS,
WALTER?
>> YOU'RE THE BOSS, LINDA, GO,A
HEAD.
[LAUGHTER]
>> I TRY TO BE BUT--LET'S SEE,
WE HAVE 2 BUSINESS ITEMS, 1
SHOULD BE VERY BRIEF, AND EASY
TO MANAGE.
AND THAT IS THE APPROVAL OF THE
MINUTES FROM THE NOVEMBER
MEETING LAST YEAR.
I THINK ALL OF YOU WERE IN
ATTENDANCE INCLUDING THE FOLKS
WHO HADN'T OFFICIALLY BEEN
APPROVED YET, BUT BY NOW, YOU
CAN VOTE, SO THEY WERE SENT LAST
WEEK AND IN HOPES THAT YOU ALL
HAD A CHANCE TO LOOK AT THEM,
THERE'S A LITTLE BIT LONG TO
TAKE TIME OUT OF THIS MEETING TO
REVIEW THEM BUT ARE YOU ALL
READY TO GIVE US A MOTION ON
WHETHER THOSE MINUTES SHOULD BE
APPROVED OR NOT?
IF SOMEBODY COULD MOVE FORWARD
WITH A MOTION WHO HAD A CHANCE
TO READ THEM?
DID ANYBODY READ THEM?
>> IF MY VOTE COUNTS, I AM HAPPY
TO SERVE THAT PURPOSE IF I AM
ABLE TO.
>> PROPOSE A MOTION.
>> IS THAT MOTION TO APPROVE
MAGGIE, SO MOTION TO APPROVE THE
MINUTES FROM THE NOVEMBER
MEETING.
OKAY.
>> I'LL SECOND THAT.
>> THANK YOU.
SO IF IT WOULD BE OKAY WITH
EVERYONE COULD YOU SEND A QUICK
AGREE WITH THE MOTION TO THE
CHAT.
OR IF YOU LIKE CAN YOU I CAN SEE
EVERYBODY EXCEPT FOR IRMA.
>> THERE WE GO.
I THINK WE HAVE A QUORUM.
>> BETH DID HAVE YOU SOME
REVISIONS THAT NEEDED TO BE
MADE?
>> YOU HAVE A HAND UP.
>> SORRY.
>> OKAY.
>> THIS COMIDEE HAS A CHAIRMAN,
AND A CHAIR IS AN
CERTAINLY--CERTAINLY LECTED
OFFICIAL WHO IS NOMINATED AND
CERTAINLY--CERTAINLY LECTED BY
THE OFFICIAL MEMBERS OF THE
COMMITTEE THAT WOULD BE
BASICALLY ALL OF YOU, DAN, YOUR
TERM HAS FINISHED OUT BUT WE
WOULD DEFINITELY LIKE YOU TO
WEIGH IN IF YOU LIKE.
SO THE CHAIR, COMMITTEE SERVES A
3 YEAR TERM, OUR VERY FIRST
CHAIRMAN OF THE IPRCC BACK IN
2012 WAS STORY LANDIS AND IF MY
MEMORY IS CORRECT, I BELIEVE
STORY SERVED UNTIL 2015 WHEN SHE
RETIRED FROM NIH AND NEN WALTER
STEPPED IN AS ACTING CHAIR AND
THEN WAS NOMINATED BY EARLY 2015
OR EARLY 2016 AND SO THE
CHAIRMAN SERVED A 3 YEAR TERM
AFTER WHICH WE HAVE TO GO
THROUGH THE PROCESS OF CALLING
FOR NOMINATIONS AND OF BOTHOT
NOMINATION, THERE ARE NO LIMIT
TO THE NUMBER OF TERMS, THAT A
CHAIR PERSON CAN SERVE AND SO
EVERYBODY HERE WHO'S OFFICIAL IS
ELIGIBLE FOR BEING NOMINATED.
SO OUR FIRST CALL OF BUSINESS
THEN WOULD BE TO REACH OUT TO
THIS COMMITTEE AND ASK WHO WE
WOULD LIKE TO PUT FORWARD AS A
NOMINEE FOR THE CHAIR PERSON FOR
THE NEXT 3 YEARS.
>> I'D LIKE TO NOMINATE DR. LANG
EVIN.
>> OH I'M SORRY I DID NOT
RESPOND TO YOUR E-MAIL DIRECTLY,
WALTER, I WAS GOING TO NOMINATE
DR. KOROSHETZ, TO CONTINUE.
, OKAY, LET THEM VOTE, I THINK
THEY'RE TIRED OF ME.
>> DO WE HAVE ANY RPGHT NOMINEES
TO ADD TO THE LIST?
>> DAN?
>> JUST A QUESTION, DOES THE
NOMINEE HAVE TO BE A FEDERAL
EMPLOYEE?
>> NO.
>> AND JUST AGAIN HELPING WITH
NUANCE, WALTER ARE YOU DRAWN TO
OTHER THINGS, WOULD YOU CONSIDER
BEING RENOMINATED OR--
>> YOU KNOW I WILL DO WHATEVER
PEOPLE ASK ME TO DO BUT I WILL
NOMINATE DR. LANG EVIN, BUT I
WILL DO IT AGAIN.
>> JUDGING, IS DR. LANG EVIN,
HAPPY AND WILLING TO ACCEPT IF
SHE IS VICTORIOUS.
>> WELL, I'M WILLING CERTAINLY,
AND I'D BE HAPPY TO DO THIS, I
ALSO WANT TO GIVE OTHER PEOPLE
OPPORTUNITIES IF WE WANT TO
HEAR, YOU KNOW VOICES FROM
OUTSIDE OF THE GOVERNMENT, IF
ANYBODY IS INTERESTED IN THAT
FOR SURE.
>> WELL I WILL ASK 1 MORE TIME
IF THERE ARE ADDITIONAL
NOMINATIONS, AND THEN, I--WE
HAVEN'T HAD THE SITUATION BEFORE
BUT COULD WE ASK BOTH NOMINEES
TO GIVE US A 1 MINUTE RUN DOWN
OF WHAT THEIR ASPIRATIONS WOULD
BE AS CHAIR OF THE IPRCC, AND I
THINK WE'RE ALL VERY AWARE OF
BOTH OF AND YOU ALL YOUR
ACCOMPLISHMENTS, BUT MORE WHAT
THE IPRCC WOULD SEE AS CHAIR AND
THEN WE WILL MOVE ON.
WALTER WOULD YOU LIKE TO START?
>> YEAH, I THINK, YOU KNOW AS I
MENTIONED THE IPRCC HAS BEEN SO
VALUABLE TO ALL THE PAIN EFFORTS
HERE AT NIH, THE PAIN
CONSORTIUM, THE HEAL INITIATIVE
SO I--I SEE THE IPRCC'S VALUE IS
KIND OF REALITY TESTING FOR NIH
FOLKS IN TERMS OF WHERE WE
SHOULD BE GOING IN THE FUTURE
AND YOU KNOW CLEARLY I COME FROM
A PRETTY STANDARD MEDICAL
BACKGROUND AND FROM A
NEUROLOGICAL BACKGROUND AND
THAT'S WHERE STORY CAME FROM IN
THE PAST, SO, I THINK THAT'S--IT
WOULDN'T BE A SURPRISE TO
ANYBODY GOING FORWARD BUT YOU
KNOW CLEARLY, YOU KNOW MIGHT BE
REASON TO HAVE A CHANGE NOW
AFTER TIME.
>> AND HELENE, WOULD YOU LIKE TO
TAKE SOME TIME TO GIVE US YOUR
THOUGHTS, PLEASE.
>> MY BACKGROUND IS NOT ALL THAT
DISSIMILAR TO WALTER'S IN A
SENSE THAT I TRAIN IN INTERNAL
MEDICINE AND I'VE DONE
NEUROSCIENCE RESEARCH FOR A LONG
TIME, ON--HOWEVER, BECAUSE NOW
AS DIRECTOR OF NCCIH, CLEARLY,
THE LENS THROUGH WHICH, I VIEW,
YOU KNOW AT NCCIH OF VIEW OF
PAIN IS THROUGH THAT OF
NONPHARMAICOLOGICAL APPROACHES.
THAT EXCLUSIVELY COMPLIMENTARY
LIKE OF COURSE WE'RE INTERESTED
IN ACCUPUNCTURE AND YOGA AND
THINGS LIKE THAT, BUT NCCIH'S
NEW STRATEGIC PLAN, WE STRESS
THE IMPORTANCE OF TREATING THE
WHOLE PERSON THAT PAIN IS A
SYMPTOM THAT REALLY IS PART OF A
COMPLEX, YOU KNOW SET OF FACTORS
THAT INVOLVES MANY DIFFERENT
SYSTEMS OF THE BODY IN ADDITION
TO THE NERVOUS SYSTEM AND I
THINK THIS IS WHERE FOR EXAMPLE
INIAATIVES LIKE THE MY O FACIAL
INITIATIVE, WE DON'T ALREADY
MENTION TRY TO CREATE A PICTURE
OF PAIN THAT CERTAINLY INCLUDES
THE NERVOUS SYSTEM BUT ALSO
INCLUDE PERIPHERAL TISSUES AS
WELL, SO THAT'S WHERE WE'RE
COMING FROM, AND ALSO, THE
IMPORTANT THING IS, THE BY O
PSYCHOSOCIAL NATURE OF
EVERYTHING THAT INVOLVES, HOW
PAIN AFFECT PEOPLE AND THEIR
ENTIRE LIVES INCLUDING
BIOLOGICAL, BEHAVIORIAL AND
ENVIRONMENTAL.
SO, YOU KNOW, I THINK THAT THE
HEAL INITIATIVE HAS BEEN A
REALLY GREAT EXAMPLE OF
EMBRACING THE COMPLEXITY OF PAIN
AND WE WOULD--I THINK THAT
MY--PHILOSOPHY FROM SEEKING
INPUT FROM IPRCC IS VERY SIMILAR
TO WAWALTER SAID IS TO REALLY
MAKING SURE THAT WE'RE NOT
MISSING IMPORTANT THINGS THAT
THAT ARE ON PEOPLE'S MINDS WHO
ARE LIVING IN THE PAIN FIELD
EVERY SINGLE DAY, SO, AND
HEARING INPUT AS TO THE
DIRECTION THAT WE ARE GOING NOW
AND WE SHOULD BE GOING.
>> THANKS, WOULD ANYBODY LIKE TO
ASK A QUESTION OF HELENE OR
WALTER BEFORE WE VOTE?
ALL RIGHT.
BETH, I THOUGHT YOU WERE ABOUT
TO SAY SOMETHING?
>> NO?
COULD I ASK EVERY 1 OF OUR
OFFICIAL MEMBERS OF THIS
COMMITTEE, WALTER AND HELENE,
YOU EACH GET A VOTE AND TO PUT
THAT IN THE CHAT, I THINK IT
WOULD PROBABLY BE BEST IF YOU
SEND IT TO LINDA ONLY UNLESS--IT
JUST SEEMS A LITTLE BIT MORE OF
A COMFORT LEVEL THAT WAY.
BUT IF YOU COULD SEND YOUR VOTE
IN THE CHAT TO ME, LINDA ONLY OR
IF YOU PREFER TO SEND IT TO ME
BY E-MAIL, I WOULD NEED TO
RECEIVE THAT FAIRLY QUICKLY IF
THAT'S POSSIBLE.
>> WE CAN STILL BE FRIENDS
HELENE, RIGHT?
>> [LAUGHTER]
>> ABSOLUTELY.
>> IT'S CLOSED, I WANT TO MAKE
SURE I GET THIS RIGHT.
BEAR WITH ME FOR JUST A MOMENT,
PLEASE.
>> WALTER YOU ARE CONVINCING, SO
HELENE, YOU ARE THE NEW CHAIR
FOR THE IPRCC, SO I DON'T THINK
IT CARRIES THROUGH THIS MEETING
SO WE'RE STILL GOING TO CALL
WALTER THE CHAIR OF THE MEETING,
AND THEN WE WILL MAKE A
TRANSITION OFFICIAL THROUGH
MAKING THE DIRECTOR OF NIH AWARE
AND I THINK IT EEIVETTUALLY ENDS
UP IN THE SECRETARY'S OFFICE AS
A NOTIFICATION AS WELL SO,
WALTER, THANK YOU SO MUCH FOR
ALL YOUR CONTRIBUTIONS AS CHAIR,
SO WE ARE APPRECIATING YOU ON
THE COMMITTEE AND GREAT JOB AS A
CHAIR AND A ABSOLUTE PLEASURE TO
WORK WITH AS THE DESIGNATED
FEDDAL OFFICIAL.
AND HELENE, WELCOME!
>> THANK YOU!
AND I WANT TO REASSURE THOSE
PEOPLE THAT MAY WORRY THAT WE'RE
STILL GOING TO BE INTERESTED IN
DEVELOPING DRUGS.
IT WILL BE VERY INTERESTING TO
FIND OUT ABOUT THIS COMMITTEE'S
TOPICS.
>> AND THANK YOU WALTER.
>> THANKS EVERYONE.
ALL RIGHT, SO WE WILL GO BACK TO
BUSINESS OF THE DAY, WE HAVE A
FEDERAL UPDATE FROM ELIZABETH
KATO, BRINGING TO US AN AHRQ
UPDATE, ELIZABETH, WE HAVE YOUR
SLIDES, AND I THINK THAT LEAH IS
GOING TO SHARE THEM.
PLEASE ABOUT GO AHEAD.
>> WE WILL BE WRAPPING UP THIS
SUMMER.
THAT WILL BE THE LAST SET OF
UPDATES COMING OUT FOR THE
OPIOIDS FOR TREATMENT,
NONPHARMAICOLOGICAL TREATMENTS,
NONOPIOID PHARMAICOLOGICAL
TREATMENTS AND ACUTE PAIN AND 1
OF THE OTHER PROJECTS WE HAD
GOING ON, CANNABIS AND OTHER
PLANT TREATMENTS FOR CHRONIC
PAIN IS A LIVING SYSTEMATIC
REVIEW AND THAT WILL CONTINUE TO
BE UPDATED THROUGH 2025.
WE ALSO HAVE A COUPLE OF
PROJECTS GOING ON IN CLINICAL
DECISION SUPPORT FOR PAIN
MANAGEMENT, 1 WAS A SET OF
CONTRACTS THAT WE'RE DEVELOPING
FOR CLINICIAN AND PATIENT-FACING
CDS APPS FOR CHRONIC PAIN
MANAGEMENT, PUBLICATIONS ARE IN
PROCESS, SHOULD BE COMING OUT
FOR THE NEXT YEAR AND WE'RE ALSO
SCALING UP--OR DOING A SITE TO
SCALE UP 1 OF OUR PAIN
MANAGEMENT EHR TOOLS FOR
CLINICAL DECISION SUPPORT AND
EXPECT RESULTS IN 2024.
AND JUST AN UPDATE ON THE
MANAGEMENT OF OPIOIDS OLDER
ADULTS IN PRIMARY CARE.
THE 3 GRANTS AND THE LEARNING
COLLABORATIVES ARE IN FULL SWING
AND WE HOPE TO HAVE RESULTS NEXT
YEAR.
THAT'S IT.
>> THANK YOU ELIZABETH.
>> THERE'S A QUESTION FROM BETH.
>> SO YES, IT WILL BE WRAPPING
UP AND THERE ARE NO PLANS FOR
FURTHER UPDATES AT THIS TIME.
>> COULD YOU TELL US ABOUT THE
SECOND 1?
SO THAT'S SOMETHING THAT'S
ALREADY EXISTING AND WHEN YOU
SAY IT'S A LIVING SYSTEMATIC
REVIEW, THAT MEANS THERE'S
SOMETHING PUBLISHED YOU CAN LOOK
AT THAT WE WOULD BE ADDING TO
OVER TIME?
>> CORRECT SO THAT 1 STARTED I
THINK A COUPLE YEARS AGO, AND
THE EVIDENCE-BASED PRACTICE
CENTER THAT'S MANAGING IT HAS
CONSTANT SURVEILLANCE SO EVERY
FEW MONTHS THEY PUBLISH AND
UPDATE IF THERE ARE ANY STUDIES
AND IF THERE'S ENOUGH NEW
EVIDENCE THEN THEY'LL UPDATE THE
FINDINGS.
AND SO THAT PROCESS WILL BE
CONTINUING AND IT'S AVAILABLE ON
THE EFFECTIVE HEALTHCARE
WEBSITE, KIDROP THAT IN THE CHAT
IF PEOPLE LIKE.
>> THAT WOULD BE GREAT, THANK
YOU.
SO WE CAN FIND ALL OF THEM AT
THE AHRQ WEBSITE AS WELL.
JUST NEED TO KNOW WHAT TO SEARCH
FOR.
>> SO I WILL GET THAT, FOR YOU
IN A SEC.
>> OKAY.
AND WOULD ANYONE ELSE LIKE TO
POSE ANY QUESTIONS TO ELIZABETH?
I PUT A CALL OUT EARLIER TO
OTHER FEDERAL MEMBERS IF THEY
ARE ON ASKING IF THEY HAD ANY
UPDATES, I WANT TO ASK IF
ANYTHING CAME TO MIND ON THE
LAST FEW DAYS THAT YOU WANTED TO
LET US KNOW ABOUT OR YOU'RE
STILL HOLDING ON TO NO MAJOR
UPDATES RIGHT NOW?
>> NO MAJOR UPDATES RIGHT NOW,
THE ONLY THING THAT MIGHT BE OF
INTEREST IS THAT WE ARE HAVING
PREI& D MEETING OFFERS, A
COUPLE INSTITUTE HAVE APPROACHED
US WITH RESPECT TO DIFFERENT
AREAS OF INTEREST THAT WE ARE
EXPANDING INTO THE MOST RECENT 1
WAS THE NATIONAL INSTITUTE OF
AGING AND WHILE WE WANT TO
EXPRESS IS THAT WE'RE ALWAYS
INTERESTED IN HAVING
INTERACTIONS PARTICULARLY WITH
PEOPLE WHO ARE EARLY, EARLY IN
THE DEVELOPMENT STAGE BECAUSE 1
OF THE THINGS THAT OFTEN HAPPENS
IS THAT THEY ARE WANTING TO DO
THE FIRST IN HUMAN TRIALS AND
WHAT WE WANT TO DO IS MAKE SURE
THAT THE FIRST IN HUMAN TRIALS
WHEN THEY COME TO US HAVE ENOUGH
INFORMATION TO SUPPORT THE
PROTOCOLS, AND HOPEFULLY NOT GO
ON CLINICAL HOLD, SO WE'RE VERY
OPEN TO MAINTAINING
COMPLIEWNICATIONS WITH THE
INSTITUTE WHO IS ARE IN THE
PROCESS OF BEING CONTACTED BY
PEOPLE OUT THERE WHO ARE
INTERESTED IN DEVELOPING DRUGS,
SO IT'S--IT'S PRETTY EBS
SIGHTING, IT'S AN ONGOING
DISCUSSION AND I JUST WANT TO
SHARE THAT WE ARE HAVING
DIALOGUES.
>> GREAT.
THANKS.
ANY QUESTIONS FOR RIGO BEFORE WE
MOVE ON?
THANK YOU JENNIFER, MORE INFO ON
THAT BEING RELEASED SO WE
APPRECIATE THAT.
>> SO WE WILL START INTO OUR 2
DISCUSSIONS FOR THIS AFTERNOON
THE FIRST 1 WILL GO BACK TO THE
CONVERSATION ABOUT ENHANCING THE
CLINICAL PAIN RESEARCH
WORKFORCE, AS WALTER MENTIONED
WE'RE DOING A NUMBER OF
DIFFERENT INITIATIVES TO HELP
EXPAND AND ENHANCE THE WORKFORCE
RELATED PRISM GRANTS PRECLINICAL
AND TRANSLATIONAL RESEARCH AS
WELL, THERE IS--IT APPEARS
THOUGH A REAL URGENCY IN THE
CLINICAL RESEARCH ARENA AS FAR
AS BRINGING PEOPLE INTO THE
FIELD BUT ALSO KEEPING THEM IN
THE FIELD AND SO MANY CHALLENGES
ARISE IN ORDER TO ACCOMPLISH
THOSE 2 GOALS OF BRINGING THEM
IN AND KEEPING FOLKS IN HERE.
IF YOU REMEMBER WE PRESENTED
EARLY DATA ON A SURVEY THAT WE
RAN THROUGH AT A COUPLE OF
MEETINGS WHERE THERE ARE A LOT
OF CLINICAL PAIN RESEARCHERS IN
ATTENDANCE AND ALSO SENT IT OUT
TO A NUMBER OF DIFFERENT
PROFESSIONAL ORGANIZATIONS, THAT
ARE PRIMARILY CLINICALLY
RESEARCHED FOCUSED AND WE--WE
ASKED A LOT OF QUESTIONS THERE
ABOUT, YOU KNOW WHAT RESOURCES
HAVE YOU HAD ACCESS TO FROM YOUR
EARLY CAREER ONWARD THAT WOULD
HELP YOU COME INTO THE FIELD OR
STAY IN THE FIELD OR DRIVE YOU
OUT OF THE FIELD, WHICH I THINK
ARE SOME IMPORTANT FINDINGS THAT
COME UP ALONG THAT LINE.
AND YOU KNOW KIND OF A MIXED
BAG, IT WASN'T LIKE A NATIONAL,
GLOBAL SURVEY BUT IT WAS ENOUGH
PEOPLE WHO ANSWERED THE SURVEY
TO GIVE US AN IDEA OF WHAT SOME
OF THE CRUCIAL CHALLENGES ARE
AND GIVE US ALSO SOME THOUGHTS
ON WHERE WE COULD AS AN AGENCY
FOR RESEARCH, TRY TO FILL IN
SOME OF THOSE GAPS AND SO SOME
OF THE THINGS WE WERE HEARING IS
I DON'T WANT TO SAY LACK OF
AVAILABILITY BUT LACK OF ACCESS
OVER TIME TO REALLY PROFESSIONAL
TRAINING AND MENTORING PROGRAMS
IN THE RESEARCH ARENA SO I WOULD
GET SOMEBODY IN THERE AND GET
THEM STARTED IN A RESEARCH
CAREER OR HAVE IT AS PART OF
THEIR CAREER AND THEN AND THEN
ALSO FUNDING TO BE ABLE TO
EITHER SUPPORT RESEARCH, SUPPORT
PROTECTED TIME OR GET YOU TO THE
KINDS OF MEETINGS AND NETWORKS
THAT YOU NEED TO ATTEND AS A
RESEARCHER AS WELL AS A
CLINICIAN, SO IT'S PARTLY IT'S
PARTLY THE COMPLEXITY OF
MANAGING 2 DIFFERENT CAREERS AND
THE RESOURCES AVAILABLE TO HELP
YOU DO THAT.
IT'S PARTLY WORK NOTHING A
CLINICAL ENVIRONMENT WHERE, YOUR
BENEFIT OF BEING IN THE CLINIC
MIGHT OUTWEIGH YOUR BENEFIT OF
BEING IN THE RESEARCH ARENA TO
THE EPIDEMIC CENTER THAT YOU
WORK FOR SO IN OTHER WORDS THERE
MAY BE CHALLENGES WITHIN THE
ACADEMIC SETTING ITSELF IN
ORDINANCE NUMBERER TO GIVE YOU
THE PROTECTED TIME TO MOVE INTO
A RESEARCH REALM AND SO WITH
THAT IN THE BACKGROUND, WHAT WE
WILL DO IN THE NEXT LITTLE BIT
OF TIME IS TO ASK LORA
[INDISCERNIBLE] WHO'S BEEN A
DRIVING FORCE TO GET A COUPLE OF
PROGRAMS MOVING FORWARD TO FUND
MENTORS AND FUND MENTEES IN
ORDER TO HELP EXPAND THE
CLINICAL RESEARCH NETWORK 1 OF
THESE PRPLTS THAT HAVE BEEN
RELEASED FOR FUNDING, ANOTHER 1
HAS JUST BEEN REVIEWED AND WE
HOPE TO LAUNCH IT IN THE--WITHIN
FISCAL YEAR 2022.
AND AFTER THAT WE'VE ASKED 2 OF
OUR OWN MEMBERS, DAN CARR AND
KRISTIN SONG WHO THOUGHT A LOT
ABOUT HOW WE COULD WORK WITH
PROFESSIONAL ORGANIZATIONS TO
SORT OF GENERATE INTEREST AND
IDEAS, LEARN WHAT THEY'RE DOING
AS FAR AS PROMOTE AND INTEREST
IN AND RESOURCES FOR CLINICAL
PAIN RESEARCH CAREERS.
AND SO, DAN HAS KINDLY OFFERED
TO MODERATE THAT SESSION AND
THEN WE ALL INVITED JOHN WHITE
IS HERE FROM THE ASSOCIATION OF
ACADEMIC PODIATRIST, SO WE MET
WITH SOME OF THE EARLY CAREER
STAGE FOLK WHO IS ARE PART OF
THIS ORGANIZATION AND LEARNED
THAT THEY'VE DONE A GREAT JOB
WITH THEIR TRAINING PROGRAM OVER
THE LAST 20 YEARS TO BRING
PEOPLE INTO RESEARCH AND HELP
THEM GET FUNDED AND GIVE THEM
TRAINING RESOURCES AND MENTOR
COLLABORATIVE SITUATIONS TO
REALLY HELP MOVE IT FORWARD.
SO JOHN JUST JOINED A FEW
MINUTES AGO AND I WILL ASK HIM
TO INTRODUCE HIMSELF BUT BEFORE
I DO THAT, THE OTHER PART OF THE
NEXT--OF THIS UPCOMING
DISCUSSION WILL BE LED BY
CHRISTINE SONG WHO'S BEEN
WORKING WITH DAN AND LAURA TO
HELP BRING INFORMATION TO SOME
OF THE PROFESSIONAL SOCIETY
STARTING OUT WITH THE
ANESTHESIOLOGIST TO SEE WHAT NIH
CAN DO FOR RESOURCES BUT ALSO TO
LEARN FROM THEM WHAT THEY'RE
DOING AND SO WE'LL TURN IT OVER
TO CHRISTINE AND THEN DAN WILL
MODERATE THE DISCUSSION, SO
JOHN, IF YOU WOULDN'T MIND
INTRODUCING YOURSELF RIGHT NOW,
AND THEN WE'LL GO BACK TO LAURA
FOR A QUICK UPDATE ON OUR
PROGRAMSA THE NIH.
>> SURE.
THANKS LINDA.
THANKS FOR INVITING ME, I'M JOHN
WHYTE, I'M A EXPERIMENTAL
PSYCHOLOGIST FOR 25 YEARS AND
--I WAS THE DIRECTOR OF MOSS
REHABILITATION INSTITUTE IN
PHILADELPHIA, I'M NOW AN EMERTUS
SCIENTIST THERE PARTIALLY
RETIRED AND MY RESEARCH IS
PRIMARILY ON TRAUMARTIC BRAIN
INJURY BUT I'VE ALSO HAD A BIG
INTEREST FOR MANY YEARS IN
CAREER DEVELOPMENT WHICH IS WHAT
I AM HERE FOR.
THANKS.
>> THANKS SO MUCH FOR AGREEING
TO JOIN US ON SUCH SHORT NOTICE.
MUCH APPRECIATED.
SO NOW LET'S TURN TO LAURA AND I
THINK LEAH HAS YOUR SLIDES LAURA
SO YOU CAN RUN THROUGH AND TELL
US ABOUT 2 OF THE NEW PROGRAMS.
>> OR ACTUALLY 3.
>> WELL, THANK YOU S AS WALTER E
ALREADY INDICATED NIH HAS BEEN
TRYING TO ADDRESS A NUMBER OF
ISSUES TO INCREASE THE PAIN
MANAGEMENT WORKFORCE AND THE
LIST THEY WILL PROVIDE TODAY IS
NOT AN EXCLUSIVE LIST, JUST SOME
OF THE WORKFORCE EFFORTS THAT
NIH HAS BEEN WORKING ON RECENTLY
WITHIN THE PAST YEAR OR 2, SO 1
PROBLEM THAT HAS BEEN IDENTIFIED
IN THE FIELD IS THAT THERE'S NOT
ENOUGH EARLY CAREER CLINICAL
PAIN RESEARCHERS TO REPLACE
THOSE WHO ARE EITHER LEAVING THE
FIELD OR ENOUGH TO RESPOND TO
THE INCREASE AND IN PAIN RFAs
BEING ISSUED BY NIH.
SO HEAL HAS BEEN TRYING TO
ADDRESS THIS ISSUE BY
ESTABLISHING A NATIONAL K12
SCHOLAR GRANT WHERE EARLY CAREER
CLINICAL PAIN RESEARCHERS WILL
RECEIVE ENHANCED MENTORSHIP,
GUIDANCE, TRAINING AND SALARY
SUPPORT AND PROTECTED TIME IN
ORDER TO SUBMIT THEIR FIRST
GRANT TO NIH, SO THIS IS OUR
FIRST NATIONAL K12.
I THINK WE MENTIONED AT THE LAST
IPRCC THIS CONCEPT WAS MODELED
OFF OF THE NATIONAL K12 FOR
NEUROLOGY AND PEDIATRIC
NEUROSURGERY.
>> ANOTHER WAY HEAL IS WORKING
TO INCREASE THE RATE OF EARLY
STAGE INVESTIGATORS, ENTERING
THE WORKFORCE, IS THE RELEASE OF
TRAINING SUPPLEMENTS ARE EARLY
STAGE INVESTIGATORS AND
INVESTIGATORS NEW TO PAIN
RESEARCH.
AND HEAL IS ALSO USING A SIMILAR
STRATEGY TO INCREASE THE
TRANSLATIONAL PAIN MANAGEMENT
WORKFORCE.
I HAVE AN EARLY AND MIDCAREER
SCIENTISTS TO OPEN KT
ANNOUNCEMENTS TO RECEIVE HANDS
ON EXPERIENCE IN THE TRANSLATION
OF INDUSTRY, ACADEMIC OR
GOVERNMENT RESEARCH CENTERS.
NEXT SLIDE.
AND THEN THE EARLY CAREER PAIN
RESEARCHERS ALSO HAVE INDICATED
THAT THEY NEED BETTER ACCESS TO
MENTORS AND HAVE BETTER
OPPORTUNITIES TO COLLABORATE
WITH RESEARCHERS ACROSS THE
SPECTRUM OF PAIN RESEARCH, SO
THIS IS THE FUNDING ANNOUNCEMENT
THAT WALTER WAS READING AT THE
BEGINNING OF THIS--AT THE
BEGINNING OF THE IPRCC, SO WE
ARE LOOKING FOR APPLICANTS TO
PROPOSE ESTABLISHING OR
COORDINATING CENTER THAT WILL
INCREASE MENTORSHIP AND LEARNING
OPPORTUNITIES, ESTABLISH A
NETWORK TO PROVIDE TRAINING AND
ENHANCE MENTORSHIP YEAR ROUND.
AND ESTABLISH AN ANNUAL MEETING
FOR EARLY CAREER PAIN
RESEARCHERS AND MENTORS TO
ATTEND AND LEARN FROM EACH
OTHER.
AND ANOTHER GOAL OF THIS
COORDINATING CENTER WOULD BE TO
HELP FACILITATE COMMUNICATION
BETWEEN PAIN RESEARCHERS ACROSS
THE PRECLINICAL TRANSLATIONAL
AND CLINICAL RESEARCHERS, SO
THAT WE CAN LEARN FROM EACH
OTHER AND TO BE ABLE TO PUT
FORWARD GRANTS THAT HAVE
COLLABORATIONS ACROSS THE
SPECTRUM OF PAIN RESEARCH.
ANOTHER PROBLEM THAT'S BEEN
IDENTIFY SIDE THAT THERE ARE
MENTORS TO GUIDE THE NEXT
GENERATION OF PAIN MANAGEMENT
RESEARCHERS SO IN ORDER TO
ADDRESS THIS PROBLEM, RELEASED A
MENTORING GRANT RFA TO PROTECTED
TIME FOR MENTORING FOR MIDAND
LATE STAGE HEAL INVESTIGATORS.
SO WE MODIFIED A K24 SO THAT WE
COULD ALSO INCLUDE LATER STAGE
INVESTIGATORS TO PROVIDE
MENTORSHIP OPPORTUNITIES.
AND THEN, NEXT SLIDE, AND
SIMILARLY THERE HAS BEEN A LACK
OF DIVERSITY AMONG PAYMENT
RESEARCH SPECIALISTS IN THE
WORKFORCE SO BROADER NIH
SUPPLEMENTS SPECIFICALLY TO
INCREASE DIVERSITY IN THE
SCIENTIFIC WORKFORCE HAVE BEEN
UTILIZED FOR THIS PURPOSE WITHIN
THE HEAL INITIATIVE.
AND LASTLY DURING COVID, THE NIH
PROGRAM OFFICERS WERE NOT
ATTENDING CONFERENCES WHERE WE
COULD ANSWER PIs QUESTIONS
ABOUT GRANTS AND HOW TO SUBMIT
YOUR FIRST GRANT OR ASK US
QUESTIONS ABOUT HOW TO WRITE AN
EFFECTIVE APPLICATION OR PUT
TOGETHER A BUDGET SO AS AN
ALTERNATIVE WE ESTABLISHED A
MONTHLY WEBINAR SERIES TO ANSWER
PI'S QUESTIONS ABOUT GRANT
MECHANISMS AND PROVIDE TIPS AND
TRICKEACH MECHANISM AND ALL OF
THOSE ARE ARCHIVED ON THE NIH
PAIN CONSORTIUM WEBSITE AND
HOPEFULLY CAN BE A RESEARCH FOR
THE COMMUNITY GOING FORWARD.
AND THEN MY LAST SLIDE IS THE
REQUESTS THAT WE'VE HAD FROM THE
COMMUNITY SO I'VE RECENTLY BEEN
PRESENTING AT CONFERENCES AND
SOCIETIES SPVENG WEBINARS AND
THE FEEDBACK THAT WE'VE BEEN
RECEIVING SO FAR IS THAT THE NIH
WORKFORCE EFFORTS HAS BEEN VERY
APPRECIATED AND THAT THE
COMMUNITY WOULD ENCOURAGE NIH TO
CONTINUE TO RELEASE ADDITIONAL
WORKFORCE RFAs AND/OR REISSUE
SOME OF THE WORKFORCE RFAs
THAT HAVE ALREADY CLOSED.
WE HAVE ALSO RECEIVED FEEDBACK,
BUT DUE TO THE LEAKY WORKFORCE
PIPELINE IT MIGHT BE IMPORTANT
FOR NIH TO RELEASE WORKFORCE
RFAYAs, THAT TARGET MORE
GRATES--GRATUEDUATE, MEDICAL
STUDENTS, PEOPLE IN GRADUATE OR
POST DOCTORAL TRAINING SO THAT
THEY CAN RECEIVE THE NECESSARY
TRAINING TO ALLOW THEM TO BE
ELIGIBLE TO APPLY FOR A K, F, OR
R-AWARD.
SO NIH IS CONTINUING TO EXAMINE
THE BEST WAYS TO ENHANCE THE
PAIN WORKFORCE AND WE ALWAYS
APPRECIATE AT IPRCC'S FEEDBACK
ABOUT THEIR WORKFORCE EFFORTS
AND THAT IS ALL I HAVE AND I AM
HAPPY TO THANKED OVER TO THE
NEXT SPEAKER.
>> THANKS SO MUCH WE HAVE A
COUPLE MORE ANNOUNCEMENTS ALONG
THOSE LINES, THE NEXT TIME WE
NEED IT.
WE'RE WORKING ON IT.
SO WE WILL TURN TO JOHN WHYTE
NOW AND HE WILL TELL US A LITTLE
BIT ABOUT THE PROGRAM THAT
THEY'VE HAD SUCCESS WITH.
SEAN, I DON'T SEE HIS NAME--
>> CAN I SHARE A FEW SLIDES AS
WELL.
>> ABSOLUTELY.
>> THANK YOU.
CAN FOLKS SEE THAT?
LET ME GO TO THE SLIDE SHOW.
>> YES, THANK YOU.
>> I WILL JUST TELL YOU A LITTLE
BIT ABOUT THE PROGRAM.
YOU KNOW WE BEGAN TALKING ABOUT
THE STATE OF REHABILITATION
RESEARCH IN THE 80S A LOT OF
SIMILARITIES I'VE HEARD TO THE
CHALLENGES IN PAIN, BUT REALLY,
THE TOP THING WE'RE GOING TO
TALK ABOUT IS RECRUITMENT AND
TRAINING, WE HAD VERY FEW
RIGOROUSLY TRAINED RESEARCHERS
STUDYING REHABILITATION,
PARTICULARLY P
HYSICIAN-SCIENTISTS AND NOT AS
MUCH FUNDING OR METHLOGIC
PROBLEMS, THERE'S MORE FUNDING
MOVING INTO PAIN, OBVIOUSLY BBUT
IN TERPS OF THE HUMAN RESEARCH
CAPACITY WE FELT THERE WAS A
NEED FOR DEEPER TRAINING IN
RELEVANT DOMAINS OF SCIENCE.
WE TENDED TO HAVE TRAINEES EVEN
IF THEY WERE INTERESTED IN
RESEARCH CAREERS WHO WOULD SAY
THINGS LIKE I WANT TO BE A
STROKE RESEARCHER BUT WHAT
SCIENTIFIC TOOLS DO YOU NEED TO
HAVE--WHAT ASPECT OF STROKE ARE
YOU GOING TO STUDY AND ADDRESS
AND IN A COMPLEX FIELD LIKE
REHABILITATION, THIS WAS
CHALLENGING FOR TRAINEES TO
DEFINE AND THERE WERE FEW PEOPLE
IN REHABILITATION, DEPARTMENTS
CAN STRONG RESEARCH BACKGROUNDS
TO MENTOR THAT KIND OF CAREER
TRAJECTORY, AND DEFINING OF
RESEARCH INTERESTS AND IN
CONVERSELY RELATIVELY LITTLE
INSIGHT AMONG REGEROUS NONREHAB
SCIENTISTS ABOUT HOW 1 MIGHT
APPLY REGGATIVELY REDUCTIONISTIC
TOOLS TO THE COMPLEX AND
INTERACTIVE PROBLEMS OF HUMAN
FUNCTION.
SO NO REAL IDEAL TRAINING MILIEU
EVEN FOR OUR TRAINEES.
SO THE KEY THINGS IS HELPING
PEOPLE FIND MENTORS IN
PARTICULAR WITH EXPERTISE IN
PARTICULAR DOMAINS OF SCIENCE
THAT COULD BE APPLIED TO PATIENT
PROBLEMS RATHER THAN SIMPLY
CLINICAL EXPERTISE IN A PATIENT
PROBLEM.
WE FELT THAT IT WAS IMPORTANT
THAT THEY HAVE PRODUCTIVE
RESEARCHERS WHO COULD ROLE MODEL
SUCCESSFUL FUNDING THAT THEY
FIND PEOPLE WITH DOMAINS
RELEVANT TO THEIR DIRECTION, AND
FIND PEOPLE WHO COULD PROVIDE
NOT JUST THEIR OWN ADVICE AND
MENTORSHIP BUT WHO COULD IMP
MERC THE TRAINEE IN A MILIEU AND
IDEALLY A MULTIDISCIPLINARY
MILIEU THAT MODELED THE KINDS OF
RESEARCH THAT THEY WANTED TO
MOVE INTO.
BUT BECAUSE WE WERE COBBLING
TOGETHER A MENTORSHIP FOR
SCIENTIFIC TRAINING THAT WASN'T
REALLY WELL REPRESENTED ANYWHERE
IN OUR FIELD WE FELT THERE
NEEDED TO BE CONCURRENT
METAMENTORSHIP IF YOU WILL,
OVERARCHING GUIDANCE ON HOW DO
YOU PUT ALL THESE PIECES
TOGETHER AS YOU MOVE THROUGH A
COMPLEX CLINICAL RESEARCH
CAREER, MANY OF THE SORT OF
COMPLEXITIES THAT LINDA ALLUDED
TO IN HER REMARKS AT THE VERY
BEGINNING.
SO, IN 1995, WE WERE ABLE TO
OBTAIN A GRANT FROM NCMRR AND
NCIHD K-12 GRANT SPECIFICALLY
FOR FIZZIAC TRYSTS INTERESTED IN
RESEARCH CAREERS AND IT WAS UND
FUNDED FOR 5 YEARS AND WASN'T
RENEWED.
AND THEN IN 2002, I WAS TASKED
TO WRITE THE REVISION THAT WOULD
FIX SOME OF THE HOLES IN THE
INITIAL RUN AND WE FEEL THAT
MODEL WAS QUITE SUCCESSFUL AND
CONTINUED THROUGH 2017 AT WHICH
TIME NCMRR BEGAN ENDING CAREER
SPECIFIC K12 GRANTS AND SO ON AT
THE PRESENT TIME IT WAS MORPHED
INTO AN R25 GRANT.
BOTH THE ORIGINAL KTBEFUL AND
THE CURRENT GRANT SHARE AN
IMPORTANT INFRASTRUCTURE WHICH
IS AN ANNUAL 2 AND HALF DAY
RESEARCH CAREER DEVELOPMENT
WORKSHOP THAT OCCURS AT OUR
ANNUAL PROFESSIONAL SOCIETY
MEETING AND THAT HAS
INCREASINGLY AS THERE ARE MORE
AND MORE TRAINEES AND MORE AND
MORE LEVELS TRACKS THAT ARE
TAYLORED TO DIFFERENT LEVELS OF
YOU KNOW--DIFFERENT
DEVELOPMENTAL LEVELS, AND THEN
THROUGHOUT THE YEAR, RERUN
QUARTERLY SMALL GROUP
TELECONFERENCES WITH EITHER
MYSELF OR THE CO DIRECTOR OF THE
PROGRAM CURRENTLY MICHAEL BONING
ER, WE MEET WITH 3 OR 4 TRAINEES
AT A TIME FOR AN HOUR 4 TIMES A
YEAR WHERE THEY REVIEW GOALS
THAT ARE INITIALLY CREATED AND
THE GOALS ARE TAYLORED TO
WHATEVER THEIR DEVELOPMENTAL
LEVEL IS INLET K12 VERSION, WE
SHEPHERDED THEM ALL THE WAY TO
THE POINT WHERE WE WOULD AWARD 2
OR 3, 3 YEAR FELLOWSHIPS AND AND
LOOK FOR FUNDING BUT SINCE THE
R25 WE'RE SENDING ALL OF THE
TRAINEES OUT INTO THE WORLD TO
FIND OTHER FUNDING BUT THE
GUIDANCE THAT WE PROVIDE IS VERY
SIMILAR, WE'VE WRITTEN PUBLISHED
2 PAPERS THAT LOOK AT THE
OUTCOMES OVER RELATIVELY LONG
AND NOW EVEN LONGER PERIODS OF
TIME THAT I THINK SUPPORT THE
CONTENTION THAT IT'S BEEN A
SUCCESSFUL PROGRAM BUT IT'S
DIVIDED INTO 3 PHASES, IF YOU
WILL, THE PREAPPLICANT PHASE,
WHICH IS FOR PEOPLE WHO NEED TO
BE WORKING ON DEFINING THEIR
INTENDED CAREER DIRECTION TO
IDENTIFY PRIMARY MENTOR AND TO
BUILD A BIOSKETCH THAT IS
COMPETITIVE FOR EXTRAMURAL
CREATIVE FUNDAMENTAL DIRECTING
SO MANY FOLKS COME IN WITHOUT A
LOT ON THEIR RESUMES SO THEY
NEED TO PUBLISH PAPERS WITH A
LOCAL MENTOR AND GET TRACK
RECORD GOING BEFORE THEY'RE EVEN
A CREDIBLE CANDIDATE AND THEY
HAVE ON NO CLUE WHAT SET OF
MENTOR SYSTEM REALLY GOING TO BE
GOOD FOR THEM IN THE LONG RUN OR
XCTLY HOW TO DEFINE WHERE THEY
WANT TO GO, SO THOSE ARE THE
GOALS THAT COME TO THE ANNUAL
WORKSHOP BASED ON AN APPLICATION
AND A NOMINATION FROM THEIR
DEPARTMENT CHAIR.
WE ACCEPT 12 OR SO NEW PEOPLE A
YEAR AND AS WELL AS PEOPLE
RETURNING FROM PRIOR YEARS AND
IN THE PREAPPLICANT PHASE,
THERE'S THE MOST DIDACTIC
CONTENT.
WHAT THE HECK DOES THIS CAREER
LOOK LIKE?
WHO FUNDS IT WHO'S THE PROCESS
LIKE?
WHAT DO YOU NEED TO DO?
A WHOLE BUNCH OF STUFF THAT IS
OVERWHELMING, BUT A LOT OF SMALL
GROUP WORK AND IMPORTANTLY THE
FOLKS FROM ALL THE DIFFERENT
LEVELS ARE TOGETHER AND
EVERYTHING THAT'S SCARE SEYOU
KNOW, REASSURED BY THE PERSON 2
YEARS AHEAD OF YOU THAT YOU CAN
GET THROUGH IT AND AGAIN SMALL
GROUP TELECONFERENCES THAT FOR
THIS GROUP ARE REALLY TO
CONTINUE TO--WHO HAVE YOU LOOKED
AT FOR MENTORS, YOU KNOW, WHERE
ARE YOU THINKING OF GOING FOR
YOUR FELLOWSHIP, THOSE KINDS OF
THINGS.
IN THE APPLICANT PHASE, THEY
MOVE INTO THIS PHASE WHEN THEY
FOUND A CREDIBLE DEVELOPMENT
MENTOR AND HAVE SOME REASONABLY
WELL FORMED SPECIFIC AIMS IF ARE
FOR A CAREER DEVELOPMENT
RESEARCH PROJECT.
AND WHEN WE APPROVE THE MOVING
INTO THIS PHASE WHEN WE OFFER
THEM AGAIN IS AT THE ANNUAL
TENDANCE NOW WITH MORE ADVANCED
CONTENT AND AND WE CONTINUE TO
HAVE THE QUARTERLY CALLS BUT
IMPORTANTLY NOW, THEY--WE OFFER
THEM 2-3 PREREVIEWS OF GRANT
APPLICATIONS ANNUALLY.
CAREER DEVELOPMENT GRANT
APPLICATIONS OR IN SOME CASES
RESEARCH GRANTS, SOME OF OUR
FOLKS FEEL IT'S MORE REALISTIC
TO DO MORE INCREMENTALLY
AMBITIOUS RESEARCH GRANTS THAN
TO GO INTO A FORMAL K-PATH BUT
WHICH EVER WE WILL DO PREVERMEN
INFECTED VIEWS WHICH WILL RESULT
IN THEM DECIDING THEY'RE NOT
ABLE TO SUBMIT OR SUBMITTING
WITH A BETTER APPLICATION AND
WE'VE HAD VERY GOOD SUCCESS WITH
FOLKS MOVING ON TO SUCCESSFUL KK
AND R FUNDING.
THE GRANTS ARE REVIEWED BY ME OR
MIKE [INDISCERNIBLE] OUR
MULTIDISCIPLINARY ADVASERY BOARD
AND A GRADUATE OF OUR PROGRAM SO
THAT EVERYBODY GETS EXPERIENCE
AND MORE AND MORE SENIOR REVIEWS
USING THE NIH REVIEW TEMPLATES
AND THEN IN THE LAST PHASE, THE
FUNDED PHASE, YOU MOVE INTO THIS
PHASE WHEN YOU GET FUBDING FROM
ANOTHER AGENCY AND HERE WE
MAXIMIZE SUPPORT FROM ASHING
FUNDING DURING CAREER
DEVELOPMENT AND ALSO IMPORTANTLY
FACILITATING THE TRANSITION TO
INDEPENDENT WHICH IN- VOLVES
NEGOTIATING A NEW POSITION OR
NEGOTIATING A PACKAGE OF SOME
KIND AND SO ON, AND HERE AGAIN,
THE QUARTERLY TELECONFERENCES
AND THE WORKSHOP FOCUS ON MORE
ADVANCED CAREER ISSUES, I THINK
THE--JUST 1 GENERAL THING I WILL
SAY IS THE ADVICE I GOT IN
WRITING THE FIRST GRANT IN WHICH
HAS PROVEN SO TRUE IS THAT THE
CULTURAL TRAINEES OF THE
TRAINEES, IS THAT THEY SUPPORT
EACH OTHER, AND IT'S WONDERFUL
TO SEE, WE WOULD WOULDN'T HAVE
THAT.
WE HAVE TRAINING RUNNING
FROMICLETAL TO PEDIATRIC, TO
GERIATRIC, ALL THE POINTS ON THE
SPECTRUM, PRECLINICAL TO HEALTH
AND SERVICES, POPULATION, HEALTH
A LOT OF INCORPORATION OF
BIOSOCIAL MODELS WHICH I PRESUME
WILL BE OF INTEREST TO YOU ALL
AND A COUPLE YEARS AGO WHEN WE
PUBLISHED OUR MOST RECENT UPDATE
WE LOOK AT THE LOCATION OF
TRAINEES, CURRENT TRAINEES AT
THAT TIME BUT IMPORTANTLY THE
RED STARS ARE CURRENT DEPARTMENT
CHAIRS WHO ARE FORMER GRADUATES
OF THE PROGRAM AND WE'RE NOW
LEADING ACADEMIC DEPARTMENTS,
WEARING A HAT THAT REALLY
UNDERSTANDS THE DEVELOPMENTAL
TRAJECTORY OF THAT CAREER AND
START PROVIDING THAT SUPPORT
INTERNAL TO THEIR OWN ACADEMIC
MECHANISM RATHER THAN RELYING SO
MUCH ON A NATIONAL
INFRASTRUCTURE BUT YOU CAN SEE
THAT'S TRUE IN 5 PLACES AND WE
HAVE VICE CHAIRS OF RESEARCH AND
MORE PEOPLE COMING OUT ALL THE
TIME SO I THINK WE'VE HAD A REAL
IMPORTANT IMPACT ON THE FIELD
AND I WILL STOP THERE AND I
WOULD BE HAPPY TO DISCUSS
ANYTHING.
>> I WILL TURN THE DISCUSSION
OVER TO DAN NOW, WE HAVE TIME
FOR QUESTIONS NOW, DAN OR
HOWEVER YOU WANT TO PLAY IT,
HAVE CHRISTINE JOINING IN AFTER
QUESTIONS OR BEFORE?
>> NO I'M JUST HAPPY TO
INTRODUCE THIS BUT I WANTED TO
GET THE BALL ROLLING BY ASKING A
QUESTION, IF YOU WERE TO BACK
OFF AND LOOK AT THE OVERALL
STRUCTURE THAT YOU HAVE ARRIVED
AT, IS THERE ENOUGH NUMBER AND
DESCRIPTION AVAILABLE OF THE
STRUCTURES SUCH AS WHAT YOU HAVE
PRESENTED BUT CAST IN A
DIFFERENT FORM SUCH AS LOOKING
AT A DIFFERENT NUMBER OF PHASES,
DIFFERENT NUMBER OF ROLES
BECAUSE WHAT YOU DESCRIBED
UNDOUBTEDLY IS SUCCESSFUL AND
INFORMAIVE IT BUT THINK BEING
THE OVERALL NEED TO DEVELOP THE
BROAD WORKPLACE.
I WONDER WHAT FEATURES HAVE YOU
DESCRIBED?
WHICH COULD BE GENERALIZABLE AND
TRANSPORTABLE OR OTHERS?
I KNOW IT'S A BROAD QUESTION AND
MAYBE JUST TO GET THE BALL
ROLLING?
>> ONE TECHNOLOGY TRANSFER I
THINK I SAID WAS THAT SOME
STRUCTURE THAT PUTS PEOPLE AT
DIFFERENT LEVELS WHO ARE ALL
ENGAGED IN SAME CHALLENGING TASK
IN CLOSE CONTACT AND IN A SOCIAL
SUPPORTIVE WAY IS A REALLY
IMPORTANT THING PARTICULARLY FOR
PREVENTING PEOPLE'S DEPARTURE
BECAUSE THERE'S A LOT OF
FRUSTRATION AND A LOT OF FAILURE
ALONG THE WAY AND TO HEAR THAT
NORMALIZED AND SUPPORTED IS
REALLY IMPORTANT.
I DON'T KNOW THAT THE 3 PHASES
IS THAT FITS MORE BROADLY AND I
KNOW OUR TRAINEES EVERY YEAR AS
THE PROGRAM ENDS WE GET A LOT OF
BOTH WRITTEN FEEDBACK BUT A LOT
OF OPEN VERBAL FEEDBACK AND AND
AS THE PROGRAM HAS MATURED,
PEOPLE HAVE SAID, MORE AND MORE
WHEN THEY VALUE ARE SMALL GROUP
ACTIVITIES WITH PEOPLE WHO ARE
MORE SENIOR TO THEM WHO CAN TALK
IN A RELATIVELY INDIVIDUALLY
TAILORED WAY SO THE BALANCE OF
MORE DIDACTIC AND STANDARD TO
MORE, YOU KNOW TOPICAL BUT
FACILITATED INDIVIDUALIZED HAS
SHIFTED DEFINITELY TOWARD THE
LATTER OVER THE YEARS.
>> OF COURSE, WHAT WOULD BE THE
COMPONENTS ACROSS THE DIFFERENT
SOCIETIES THAT HAVE DIFFERENT
PATIENT POPULATIONS, DIFFERENT
TECHNIQUES AND SO ON, WHAT COULD
BE IN COMMON AND WHAT COULD BE
DISTINCTIVE TO FIT INTO A
WORKFORCE DEVELOPMENT QUALITY
ASSESSMENT'RE THERE OTHER POINTS
PEOPLE WOULD LIKE TO MAKE OR
VOLUNTEER THINGS FOR INDIVIDUALS
EXPERIENCE OR INSTITUTIONS
EXPERIENCE.
>> DR. WHYTE OR DO WE WANT TO
PROCEED TO DR. SONG?
>> NO, REALLY I THINK THAT I SEE
A LOT OF PARALLELS IN THE SENSE
THAT I DON'T WORK IN PAIN
MYSELF, BUT IT SEEMS TO ME THAT
IN ANY FIELD WHERE A MATURE
SCIENTIST IS LIKELY TO BE
WORKING IN A MULTIDISPLENARY
TEAM SETTING THAT MAKES THE
TRAINING OF THE SCIENTISTS FOR
THAT CAREER MORE CHALLENGING
BECAUSE IN MY EXPERIENCE, THERE
AREN'T AS MANY GOOD ROLE
MODELING OF THAT
MULTIDISCIPLINARY TEAM SCIENCE
TO PREPARE THE PERSON FOR THAT.
SO PART OF WHAT I THINK IS A
CHALLENGE FOR AREAS OF SCIENCE
THAT ARE ESPECIALLY COMPLEX AND
MULTIDISCIPLINARY IS FIGURING
OUT THE TRAINING PATHWAY THAT
DOESN'T EXPECT THE TRAINEE TO
PUT TOGETHER WHAT IN MY OPINION
IS THE MOST COMPLICATED PART OF
THE TASK LIKE YOU WILL GET A
LITTLE OF THIS AND I LITTLE OF
THAT AND YOU WILL FIGURE OUT HOW
IT BECOMES A COMPOSITE.
SO THAT'S KIND OF 1 OF THE KEY
PURPOSES OF THAT METAMENTORSHIP
AND WHAT COMBINATION OF MENTORS
AND WHAT KINDS OF PROBLEMS WILL
GIVE YOU THE BEST EXPOSURE TO
THE KINDS OF THINGS THAT WILL
HELP YOU GO WHERE YOU WANT TO
GO.
>> JUST LOOKING AT THE
EVALUATION PROCESS, THE
APPLICATION PROCESS FOR THE
MENTEES, YOU GET ALL THE STEPS
FILLED IN AND SO MANY SO MANY
GOOD COLLABORATIONS OVER THE
PROGRAMS, IS THERE--A CHALLENGE
THAT YOU MET WITH BRINGING IN
THE BEST MENTORS INTO--I DON'T
WANT TO SAY YOUR PROGRAM BUT IT
IS A FAIRLY WELL DEFINED PROGRAM
AND HOW DO YOU GO ABOUT
ENCOURAGING THEM TO BE MENTORS
WITHIN?
>> YOU KNOW, AGAIN WE HAVE 2
LAYERS OF MENTORS, WE HAVE THE
MENTORS FOR THE RMSTP, AND
INDEED, I MEAN, THE REASON WE
HAD THE--WE STILL DO BUT THE
REASON WE HAVE IT WHEN WE
STARTED IS THAT THERE WEREN'T
ENOUGH MENTORS LOCALLY
EVERYWHERE TO GIVE PEOPLE THAT
BIG PICTURE CAREER DEVELOPMENT
SUPPORT SO WE FELT THAT HAD TO
BE PROVIDED NATIONALLY, THERE
WERE ENOUGH OF PEOPLE PUT
TOGETHER A PAN WILL NATIONALLY
TO DO THAT JOB AND SO WE DID.
BUT THEN WE--THAT PANEL ARE
RARELILET PRIMARY MENTORS FOR
ANY OF THE TRAINEES.
TRAINEES ARE FINDING MENTORSHIP
IN A LABORATORY WHERE THEY ARE
AND/OR WHERE THEY MOVED TO,
WE'RE HELPING THEM FIGURE OUT
WHOSE LABORATORY THAT SHOULD BE
AND FIGURE OUT WHETHER THAT'S
GOING TO BE A GOOD LABORATORY
FOR THEM AND THEN THERE IS THE
QUESTION WHERE WHY IS THAT
LABORATORY INTERESTED IN HAVING
A REHAB CLINICIAN HANG OUT IN
THE LABORATORY AND WE HAVE TO
HELP THEM GET A GOOD SALES PITCH
TO ANSWER THAT QUESTION.
>> SO THANK YOU, AND I THINK WE
ARE KEEPING ON TIME, SO SPEAKING
OF EVERYBODY'S AGREEMENT, WE
WOULD LIKE TO HEAR THE
EXPERIENCE OF DR. SONG, WHO
JOINED EARLIER EFFORTS INITIATED
BY DR. PORTER AND DRS. SETIN AND
WANDNER TO GAIN A SENSE OF WHAT
THE WORKFORCE WAS AND IN
PARTICULAR TO EXPLORE WELL
BEFINED SPICIALTS SUCH AS
ANESTHESIOLOGYS WHICH HAD ITS
OWN APPROACH TO DEVELOPING A
SUSTAINABLE WORKFORCE SO
DR. SONG IF YOU ARE READY TO GO
PLEASE START IN.
>> I AM, CAN YOU HEAR ME?
>> I WILL--YES,.
>> SO I WILL SAY THANK YOU FOR
THE INTRODUCTION AND PAIN HAS
BEEN A CHALLENGE FOR MANY OF
THOSE BUILDING IN THE WORKFORCE
SO WHAT YOU HAVE PRESENTED
REALLY HAS SPOKEN TO SO MANY OF
US SO CHRISTINE, LAURA, DAN AND
I HAVE BEEN WORKING
COLLABORATIVELY WITH THE
ASSOCIATION OF UNIVERSITY
ANESTHESIOLOGISTS AUA AND THE
ANESTHESIA RESEARCH COUNCIL ARC,
AND ON MAY FOURTH HAD AN AUA
WEBINAR, PRESENTATIONS OF DATA
GENERATED AND THE MEETING
CONFIRMED IS THAT THESE 2
STAKEHOLDERS SHARE COMMON GOALS
WITH RESPECT TO THE NEED TO
CULTIVATE THE NEXT GENERATION OF
PHYSICIAN SCIENTISTS AND
ANESTHESIOLOGY INCLUDING PAIN
AND TO GROW AND TO SUSTAIN THE
PAIN RESEARCH PIPELINE OVERALL.
SO IN THE NEXT 10 MINUTES I WILL
PRESENT BACKGROUND ON AUA AS A
WEBINAR SPONSOR AND ARC AS THE
ANESTHESIA STAKEHOLDER AND THEN
NEXT I WILL PRESENT THE ARC DATA
THAT THEY PRESENTED AND ALSO I
WILL PRESENT ARC DATA THAT
ACTUALLY CAME DIRECTLY FROM 1 OF
THEIR MEETINGS IN 2021 AND THEN
I WILL SUMMARIZE THE IDENTIFIED
GAPS AND OPPORTUNITIES MANY OF
WHICH WERE DISCUSSED AT THAT MAY
2021 MEETING AND FINALLY I WILL
PRECEPT A SAMPLE OF QUESTIONS
THAT WERE GENERATED BY MEMBERS
OF THE ACADEMIC ANESTHESIOLOGY
AUDIENCE AND THE OPEN DIALOGUE
SESSION.
MANY OF THOSE PUB LIAISONYICIZED
WITHIN THIS COMMUNITY, ABOUT 200
INDIVIDUALS REGISTERED, ABOUT 50
SIGNED ON, AND THAT'S NOT BAD
CONSIDERING CONSIDERING THIS WAS
RECORDED AND ACCESSIBLE AS AN
ON-DEMAND WEBINAR.
SO THE STAKEHOLDER ARC
RECRESENTS ACADEMIC
ANESTHESIOLOGISTS AND IT WAS
FOUNDED BY THE COMPONENT
ORGANIZATION ASA, AND IARS, AND
FAER AND THEIR COLLECTIVE
MISSION IS TO ADVANCE THE
SCIENTIFIC DISCOVERY THROUGH
DEVELOPMENT AND DISSEMINATION OF
RESEARCH AND ANESTHESIOLOGY
PERIOPERATIVE AND PAIN MEDICINE.
NOW ARC HAS IDENTIFIED GAPS THAT
IS OPPORTUNITIES FOR
IMPROVEMENT, INCLUDING
DIFFICULTIES AND SUSTAINING A
CULTURE OF INQUIRY AND PROBLEM
SOLVING AND A SPECIALTY
CONSTRAINED BY FINANCIAL
IMPERIAATIVES AND IN SUFFICIENT
INSTITUTIONAL RESEARCH AND
SUPPORT AND DEVELOPMENT OF
PHYSICIAN SCIENTISTS, SO NOTABLY
THEY RECOGNIZE A CRITICAL ROLE
THAT RESEARCH PLAYS IN ADVANCING
ANESTHESIOLOGY PRACTICE AND THE
FUTURE OF THE SPECIALTY AS A
WHOLE.
SO UNDER MAX KELZ LEADERSHIP, 3
GROUPS WERE FOCUSING LEADERSHIP
AND GOALS EACH OF WHICH
ADDRESSES 3 CHALLENGES IN THE
ANESTHESIOLOGY SPACE AND SO FAR
THEY COMPLETED THE FIRST YEAR OF
THE PILOT AND VIVIAN WAS A
MEMBER OF THE WORKING GROUP YEAR
1 AND PRESENTED THEIR DATA AT
THE AUA WEBINAR LAST MONTH.
AND TO DISCOVER AND CLINICAL
SCIENCE WHICH ARE THREATENED BY
THE TECLIEN IN THE PHYSICIAN
SCIENTIST WORKFORCE.
SO THEY WERE TASKED WITH
ADDRESSING FIRST THE SCOPE OF
THE ANESTHESIOLOGIST SCIENTIST
SHORTAGE.
NEXT, IDENTIFY FACTORS
ASSOCIATED WITH SUCCESSFUL
PHYSICIAN SCIENTISTS LAUNCH, AND
THEN TO ADDRESS DIVERSITY IN THE
PIPELINE.
THEY HAVE PLANS TO EXPOSE
STRATEGIC TRAINING.
IT WAS FOCUSED ON MENTORS AND
MENTEES, FUNDING, EXPERIENCE AND
ATTITUDES ABOUT DIVERSITY AND
DEPARTMENTMENTAL SUPPORT AND
CULTURE AND HERE'S WHAT THEY
FOUND.
THEY FOUND THAT ANESTHESIOLOGY
DEPARTMENTS COULD DO MORE TO
FOSTER RESEARCH AMONG MEDICAL
STUDENTS.
FOCUSING ON THE LEFT BAR GRAPH
OVER THE PAST 5 YEARS, YOU CAN
SEE THAT A LITTLE MORE THAN HALF
OF THOSE WHO RESPONDED WERE FROM
DEPARTMENTS THAT HOSTED MEDICAL
STUDENTS PERFORMING RESEARCH.
OF NOTE, THE X-AXIS REPRESENTS
PERCENT NOT OF DEPARTMENTS.
SO NOW WHAT ABOUT RESIDENTS?
WELL, ANESTHESIOLOGY DEPARTMENTS
COULD DO MORE TO FOSTER RESEARCH
AMONG RESIDENTS, A LITTLE MORE
THAN HALF OF THOSE RESPONDED
WERE FROM DEPARTMENTS THAT OFFER
RESEARCH TRACKS TO
ANESTHESIOLOGY RESIDENTS.
AND HERE YOU CAN SEE ON THE GRAF
IN THE RIGHT OVER THE PAST 5
YEARS, THE MAJORITY OF RESIDENT
VS NOT PARTICIPATE INDEED ANY
STRUCTURED RESEARCH DURING
RESIDENCY.
THERE WERE QUESTIONS IN THE
SURVEY THAT ADDRESSED BARRIERS
IN MENTORING A DIVERSE
ANESTHESIOLOGY PHYSICIAN
SCIENTIST PIPELINE, CAN YOU SEE
THAT MORE MENTORS HAVE MENTORED
WOMEN THAN HAVE BEEN MENTORED BY
WOMEN.
LIKEWISE, HERE, YOU CAN SEE THAT
MORE MENTORS HAVE MENTORED THOSE
IN UNDERREPRESENTED RACIAL OR
ETHNIC GROUPS.
AND HAVE BEEN MENTORED BY
PHYSICIAN SCIENTISTS IN
UNDERREPRESENTED RACIAL OR
ETHNIC GROUPS THEMSELVES SO
THESE DATA REPRESENT A TREND,
GLASS IS HALF FULL, THEY SUGGEST
A POSITIVE TREND TOWARDS MORE
ANESTHESIOLOGIST-SCIENTISTS WHO
ARE FEMALE OR UNDERREP AREY
SEBTED GROUP RACIAL GROUPS IN
THE FUTURE BUT WE'RE NOT DOING
ENOUGH AT THIS POINT.
THE SECOND SURVEY WAS
DISTRIBUTED TO 36 DIRECTORS OF
DEFINED RESEARCH TRACKS IN 36
ANESTHESIOLOGY DEPARTMENTS AND
EVALUATED THE CHARACTERISTICS OF
THESE TRAINEES.
THE DIRECTORS FROM 14 OF 16232
PROGRAMS RESPONDED WITH ALL
HAVING ON THE LEFT SIDE, AND
MORE OVER ONLY 9 OF THEM LOOK ON
THE RIGHT SIDE NOW, 64% REPORTED
AT LEAST HALF OF THEIR T32
TRAINEES ARE STILL CONDUCTING
RESEARCH.
DATA WERE OBTAINED FROM A 2
PRIMARY ANESTHESIA FOUNDATIONS,
TO EVALUATE THE CHARACTERISTICS
AND OUTCOMES OF THEIR RESPECTIVE
2-YEAR, MENTORED RESEARCH
TRAINING GRANTS MRTGs, THESE
ARE TYPICALLY OBTAINED AFTER
CLINICAL TRAINING.
AT LEAST SINCE 2015 AND ALMOST
ALL OF THE AWARDEES HAVE FIRST
HAD ADDITIONAL RESEARCH TRAINING
EITHER WITH A Ph.D. OR A T32,
SIMILARLY, FROM IARS, THE OTHER
ANESTHESIA RESEARCH FOUNDATION,
RMD APPLICANTS WERE MORE LIKELY
TO,A PLIE FOR MD-PH Ds AND
APPLICANTS OTHER THAN MORE
LIKELY TO RECEIVE THESE GRANTS.
YOU CAN SEE THAT DURING THE
PERIOD, 2010-2018, ONLY A FEW
INSTITUTIONS ARE RECEIVING THE
LARGEST NUMBER OF FAER MRTGs
AND THESE ARE ALSO THE
INSTITUTIONS RECEIVING THE NIH K
AND R-AWARDINGS AND EVEN AMONG
THESE INSTITUTIONS THERE ARE A
FEW WARKSDED AMONG THE MRTG
AWARDEES.
OKAY, THE YEAR 1 WORKING GROUP
ALSO EVALUATED NIH FUNDING
DEPARTMENTS THESE DATA ARE
PUBLICLY AVAILABLE, SO THE NIH
FUNDING TO ANESTHESIOLOGY
DEPARTMENTS HAS INCREASED OVER
TIME.
THE 5 YEAR PERIOD FROM TO TBENT
20 WHEN ADJUSTED FOR AN INCREASE
IN RESIDENCY SIZE, AND AS YOU
CAN SEE IN BLUE, THERE'S BEEN A
72% INCREASE IN TOTAL NIH
FUNDING OVER THIS 5 YEAR PERIOD
HOWEVER, THE RELATIVE RATE FOR
NIH FUNDING OVERALL IS LOW WHEN
COMPARED TO ADJUSTED SIZE
COMPARED TO OTHERS SAMPLES LIKE
FOR NEUROLOGY.
SO, OKAY, THESE DATA CONFIRM
DATA I SHOWED YOU EARLIER THAT
THE NUMBER OF T32 AWARDS TO
ANESTHESIOLOGY DEPARTMENTS HAS
INDEED REMAINED STAGINENT, THE
NUMBER OF AWARDS HAS INCREASED
OVER THE PAST 5 YEARS.
THE WORKING GROUP YEAR 1
FINDINGS, THE NUMBER OF
ANESTHESIOLOGY DEPARTMENTS WITH
T32 FUNDING HAS REMAINED
UNCHANGED OVER THE YEARS, THE
DEPARTMENTS HAS INCREASED OVER
10 YEARS BUT REMAINS LOW WHEN
BENCHMARKED TO OTHER SPECIALTY.
AND THERE'S A NEED FOR
RESEARCHERS FROM TRAINEES AND
MENTORS.
[BELL CHIMING ]
FROM UNDERREPRESENTED OR RACIAL
ETHNIC GROUPS, SOME POSSIBLE
FACTORS FOR THESE CHALLENGES,
MANY OF WHICH WERE DISCUSSED
DURING ARC'S OWN MEETING AND
BREAK OUT SESSIONS IN 2021.
THEY INCLUDE NATIONAL LEVEL, PRO
RECOGNITION OF THE
ANESTHESIOLOGY RESEARCH, DIVERSE
AND MULTIDISCIPLINARY NATURE OF
ANESTHESIOLOGY RESEARCH, LACK OF
DIVERSITY IN THE RESEARCH
WORKFORCE AND THE NEED FOR
CAREER DEVELOPMENT PROGRAMS AT
ALL STAGES OF CAREER.
WHETHER OR NOT STAKEHOLDERS CAN
OPTIMIZE IMPACT WITH NEW
INITIATIVES AND HERE ARE SOME
THAT ARE DISCUSSED IN THE
ANESTHESIOLOGY SPACE, AND THEY
ALIGN WITH MANY OF OUR
DISCUSSION, ATTRACT MEDICAL AND
EVEN UNDERGRADUATE STUDENTS TO
ANESTHESIA STUDENTS THROUGH
GRANT MECHANISMS THIS, IS OF
ACTUALLY GREAT IMPORTANCE TO
ARC.
NETWORKS AROUND QUESTIONS THAT
GARNER INSTITUTIONAL INTEREST TO
FOSTER CROSS DEPARTMENTMENTAL
COLLABORATION.
SUPPORT MENTORSHIP NETWORKS IN
BETWEEN INSTITUTIONS AND
RECOGNIZE INTERDISCIPLINARY
TEAMS BY INTEGRATING AND
COORDINATING TRAINING EFFORTS
AND FUNDING MECHANISMS AND
REFINE METRICS AND CAREER
DEVELOPMENT AND PROGRESSION.
IN OUR MAY AUA OPEN SESSION, OUR
PRIMARY OBJECTIVE WAS TO
ESTABLISH NEW DIALOGUE AND
UNLOCK PATHWAYS TO GROW AND
RETAIN THE ANESTHESIOLOGY PAIN
RESEARCH WORKFORCE, ACTUALLY THE
QUESTIONS AND COMMENTS WERE
ALMOST ENTIRELY DIRECTED TO NIH
AND SPECIFICALLY TO LAURA.
OF COURSE WE ONLY HAD ABOUT 15
MINUTES.
HERE ARE 3 EXAMPLES OF THESE
QUESTIONS.
SO FAIR SUPPORT OF THE
DEVELOPMENT PLANNED GEM STARS
THESE ARE 2-YEAR RO3 NIA GRANTS
TO SUPPORT MEDICAL AND SURGICAL
SPECIALISTS TRANSITIONING TO
AGING RESEARCH, THE QUESTION WAS
NINDS AND OTHER INSTITUTES
CONSIDER FUNDING FOR SIMILAR
MECHANISMS THAT ALLOW RESEARCH
FOUNDATIONS TO SUPPLEMENT THESE
PROFESSIONAL DEVELOPMENT TRENDS.
SIMILAR TO WHAT [INDISCERNIBLE]
HAS BEEN DOING WITH NIA.
THE ANOTHER QUESTION WAS WHAT
NIH EXPLORING OR ADVANCING
ANESTHESIOLOGY PARTNERSHIPS WITH
RESEARCHERS FROM OTHER
DISCIPLINES?
SO THIS WAS A LITTLE EASIER AND
A THIRD QUESTION WAS ABOUT
EXPOSING PREDOCTORAL STUDENTS TO
RESEARCH SPECIFICALLY THE T35
SHORT-TERM INSTITUTIONAL NRSAs
FOR MEDICAL STUDENTS.
THE QUESTION WAS WOULD THE NIH
CONSIDER EXPANDING T35S TO ALLOW
STUDENT ENROLLMENT AT MULTIPLE
INSTITUTIONS.
AS I MENTIONED, ARC IS VERY
INTERESTED IN EXPOSING MEDICAL
STUDENTS TO RESEARCH IN
ANESTHESIOLOGY.
AND JUST AS AN ASIDE, I SHOULD
DISCLOSE THAT I MYSELF WAS A
BENEFICIARY OF 2 INSTITUTIONAL
NRSAs, AN NHLBI T35 AS A
MEDICAL STUDENT AND THEN IN
ANESTHESIA T32 FELLOWSHIP AND
THEN I WAS A STAFF FELLOW AT
NIDR, NIDCR AND NOW I'M A CO
MENTOR ON A NI DA K23 SO I AM
ALSO A FIRM BELIEVER IN PLANTING
THE SEED EARLY.
SO DID WE MEET THE GOALS OF THIS
MEETING, WE SHOULD CLEAR
ALIGNMENT BETWEEN BOTH NIH AND
ARC OF THE IDENTIFIED RESEARCH
WORKFORCE GAPS AND CHALLENGES
AND STRATEGIC GOALS AND SO,
THEREFORE IT WAS AN OPPORTUNITY
FOR STAKEHOLDERS TO ACKNOWLEDGE
A COMMON VISION AND A COMMON
MISSION AND SO, THE PROPOSED
ASSURED VISION AND MISSION THAT
COULD BE CONSIDERED AMONG
STAKEHOLDERS, APPROVED BY ARC
THROUGH [INDISCERNIBLE], AND
HERE'S A ROBUST ANESTHESIOLOGY
PAIN RESEARCH INFRASTRUCTURE
COMPRISED OF PHYSICIAN-TESTIFIES
AT ALL STAGES OF CAREER
DEVELOPMENT OAZ WHOSE WORK
INFORMS OUTSTANDING PATIENT CARE
THROUGH NOVEL DISCOVERIES AND
TECHNOLOGIES, JUST FOR YOU TO
CONSIDER.
OKAY, THANK YOU SO MUCH AND
FINALLY THE WEBINAR COULD NOT
HAVE HAPPENED WITHOUT EACH OF
THESE INDIVIDUALS.
>> THANK YOU DR. SONG AND AS
BEFORE, I WONDER IF THERE ARE
QUESTIONS RIGHT NOW, I HAVE A
COUPLE OF MY OWN TO POSE BUT ARE
THERE ANY IMMEDIATE SERIES OF
QUESTIONS FROM THE ATTENDEES
DRIVEN BY DR. SONG'S VERY
PREICIZE BIEW THOROUGH
PRESENTATION.
IS SOMEONE MUTED?
SO LET ME JUST START OWF, WE ARE
DOING WELL TIMEWISE AND AS I'M
HEARING ALL OF THESE DIFFERENT
WONDERFUL PRESENTATIONINGS, I'M
THINKING, THAT THERE MIGHT BE
SOME IMAGINARY SYSTEMATIC
REVIEW, YOU KNOW WE SEE
SYSTEMATIC REVIEWS LIKE, BACK
PAIN SCHOOLS FOR LONG-TERM
BENEFIT OR A AS THE INTERVENTION
APPLIED TO CONDITION B AND THE
TITLE OF AN IMAGINARY SYSTEMATIC
REVIEW MIGHT BE FORMAL TRAINING
PROGRAMS TO INCREASE PAIN
RELATED RESEARCH WORKFORCE.
BECAUSE I FEEL LIKE IT'S USED A
PARLANCE OF EVIDENCE BASED
MEDICINE WE'VE BEEN HEARING
WONDERFUL NARRATIVE REVIEWS BUT
THERE DO SEEM TO BE COMMON
ELEMENTS, COMMON ASSUMPTIONS
THAT ARE SHARED AND IT MIGHT BE
WORTH THINKING IN THE FUTURE OF
PROGRAMMATIC OR SYSTEMATIC WAY
MUCH AS 1 WOULD CONDUCT A
SYSTEMATIC REVIEW OF ANY
INTERVENTION FOR ANY CONDITION
OR STATE OR PREVENTION, EVEN.
SO I WILL THROW THAT OUT.
I DON'T KNOW HOW PEOPLE WOULD
RESPOND TO THAT BUT ARE--FURTHER
QUESTIONS OF DR. SONG?
>> I HAVE A QUESTION REAL QUICK,
DAN.
SO DR. SONG THAT WAS NICE, MY
FIRST QUESTION WOULD BE KNOWING
THAT MANY OF OUR ACADEMIC
INSTITUTIONS THAT DO TRAINING
FOR RESIDENCY PROGRAMS AND
ANESTHESIOLOGY ARE SLOWLY SORT
OF LEAVING THE ACADEMIC WORLD
AND BEING LET'S SAY BOUGHT UP BY
LARGE HEALTHCARE PRACTICES AND
KNOWING THE FACT THAT THERE'S
VERY LITTLE SUPPORT FOR THE
ACADEMIC OR RESEARCH MISSION,
HOW DOES SOMETHING LIKE THAT
SORT OF PLAN TO THE STATISTICS
OF NOT ONLY WHAT YOU'RE SHOWING
HERE BUT JUST ACROSS THE BOARD
AND THE FACAS LACK OF PHYSICIAN
SCIENTISTS IN THE IDEA THAT MANY
OF THESE VERY LARGE IN ARIZONA
WE'VE BEEN BOUGHT UP BY BANNER
VERY LARGE MEDICAL INSTITUTIONS
THAT JUST REALLY DON'T WANT THE
RESEARCH MISSION AS MUCH AS THEY
SAY THEY WANT TO BE A PART OF
IT, THEY JUST DON'T SUPPORT IT.
>> YEAH, THAT'S A GREAT QUESTION
AND PARTICULARLY NOW HAVING
LIVED THROUGH A PANDEMIC FOR THE
LAST 2 AND HALF YEARS,
PARTICULARLY JUNIOR STAFF ARE
OVERWORKED, FEEL VERY UNDER
FULFILLED AND IT'S BECOME
DIFFICULT EVEN WHERE THERE HAS
BEEN SUPPORT TO CO RESEARCH
INTERNALLY, EVEN WITH EXTERNAL
SUPPORT TO AVOID I DON'T KNOW
ANY ANYONE HAS LIVED THAT OR
LIVED IT AND IT'S TOUGH.
SO,--
>> SO I JUST WANT TO SAY THAT IT
IS THE CASE AS YOU JUST ALLUDED
TO THAT THERE HAS TO BE A DRAW
TO ACADEMIC ANESTHESIOLOGY AND
PAIN AND PARTICULARLY IN
ANESTHESIOLOGY BECAUSE WE HAVE
BEEN PULL INDEED EVERY DIRECTION
OVER THE LAST COUPLE OF YEARS
BUT IN PAIN MANAGEMENT, PAIN
MECHANISM RESEARCH, IN PAIN
MEDICINE, PAIN SPACE OVERALL,
THERE HAS TO BE A DRAW THAT FITS
WHAT YOUNG PEOPLE ARE NOW
VALUING AND I THINK THAT THAT--I
THINK WE HAVE TO TAKE A STEP
BACK BECAUSE THE CULTURE HAS
CHANGED.
SO DO YOU HAVE ANOTHER QUESTION?
>> YEAH, MY SECOND QUESTION IS
THAT YOU SHOWED VERY NICELY
THERE'S AN INCREASE IN ACTUAL
FUNDING AND ANESTHESIOLOGY WHICH
WAS ACTUALLY PRETTY IMPRESSIVE
AS FAR AS GENERAL OVERALL
ALTHOUGH I KNOW THAT'S OVERALL
PRACTICES, DO YOU SEE THAT
HAPPENING IN SYRUP AREAS IF YOU
GO THROUGH NIH BLUE RIDGE IS IT
POPPING UP INTO LET'S SAY 10
DIFFERENT AREAS LIKE LET'S SAY
HARVARD WHERE MAYBE THERE'S MORE
SUPPORT.
>> SO THAT'S INTERESTING, I ONLY
GOT TO SEE THE DATA RELATIVE TO,
YOU KNOW THE DATA HAVE TO BE
BROKEN DOWN AND I'VE ACTUALLY
ASKED FOR THAT SO YOU WILL HAVE
MORE TO CHAIR HOPEFULLY WITHIN
THE NEXT FEW MONTHS.
>> THANK YOU FOR THAT QUESTION.
>> THAT WAS A GREAT QUESTION AND
A GREAT RESPONSE AND WE'RE ALL
FAMILIAR WITH LET'S SAY AGENDAS
THAT WANT TO RESULT IN MORE
INDIVIDUALS OF A CERTAIN GROUP
OR AGE OR GENDER, DOING
SOMETHING AND THERE HAS BEEN
ACCORDING TO THE DIFFERENT
CIRCUMSTANCE 1 OR OTHER
INCENTIVIZATION OR REDUCTION OF
DISINCENTIVIZATION SUCH AS A
TYPE END TO THE DEPARTMENT, I
DON'T KNOW IF THIS IS REALISTIC
BUT AN ALTERATION OF
REIMBURSEMENT RATES DEPENDING ON
WHETHER THEY'RE A TRAINING
PROGRAM OR NOT A TRAINING
PROGRAM BECAUSE SUCH GRANTS HAVE
BEEN IESKT EVALUATION PROCESS
TRADITIONALLY IN SUPPORTING
INDIRECTLY THE RESEARCH
WORKFORCE DEVELOPMENT IN
INSTITUTIONS BUT IT'S A GREAT
QUESTION AND MAYBE THIS WOULD BE
A QUESTION TO BE CONSIDERED IN
SOME AGAIN IMAGINARY DISCUSSION
AMONGST TRAINING PROGRAMS, OR
INCENTIVIZING OR
DISINCENTIVIZING DIFFERENT
MODELS OF CARE.
SO WITH THOSE THOUGHTS ON THE
TABLE, THERE IS A LOT OF ROOM
FOR DISCUSSION.
JIEWLTY, YEAH,.
>> I DO HAVE 1 ADDITIONAL
QUESTION, I THINK WORKFORCE
DEVELOPMENT PROGRAMS ARE SO
IMPORTANT ESPECIALLY IN THIS
SPACE AND I THINK THERE'S A
CORRESPONDING OUTCOME
MEASUREMENT FOR PATIENTS AND
FOLKS WHO ARE INVOFFED IN
RESEARCH ON THE OTHER SIDE, AND
I WILL JUST BE CURIOUS ON LIKE
AS TO HOW MANY KIND OF OUTCOME
MEASURES HAVE BEEN EVALUATED FOR
THAT PERSPECTIVE FOR FOLK WHO IS
HAVE RECEIVED MENTORSHIP HAVE
NOT RECEIVED MENTORSHIP AND
WITHIN THE LANDSCAPE OF THAT
PRESENTATION HOW HAVE PATIENTS
KIND OF BENEFITED OR NOT
BENEFITED FROM THEIR EXPERIENCE
RECEIVING CARE OR PARTICIPATE
NOTHING RESEARCH IN THIS WAY.
>> OOH THAT'S A GREAT QUESTION
AND ACTUALLY THAT'S A GREAT
QUESTION FOR I DON'T THINK ANY
OF US HAS AN ANSWER TO.
SO THAT IS THAT COULD BE THE
START OF A GREAT PROJECT MAYBE
LINDA HAS SOMETHING TO SAY ABOUT
THAT 1?
>> I WISH I HAD SOME ADVICE ON
HOW--WHAT WE WOULD USE FOR
METRICS TO FIGURE OUT WHAT THE
BENEFITS HAVE BEEN AND YOU KNOW
I THINK IF WE ALL SIT DOWN AND
COME UP WITH SOME THOUGHTFUL
SUGGESTIONS, WE WILL START
MOVING IN THAT DIRECTION TO SEE
WHAT DIFFERENCE IT HAS MADE.
IF YOU HAVE ANY IDEAS PUT IT IN
THE CHAT RIGHT NOW.
I'M NOT COMING UP WITH ANYTHING
REALLY CREATIVE.
THINK ABOUT IT.
>> I THINK LINDA'S INFORMATION
IS VERY IMPORTANT, WE WERE
CONDUBT DUCTING SYSTEMATIC
REVIEW, YOU WILL FIND SOME WERE
CLOSER THAN OTHERS AND AT WHAT
POINT DID THEY CEASE BEING THE
SAME INTERVENTION SIMILARLY WITH
OUTCOMES, WE CAN ALL THINK OF
OUTCOMES BUT INFECTIOUS
ENTHUSIASM FOR THE TOPIC IS THAT
SOMEHOW COMMUNICATED TO PATIENTS
WHO FEEL THEY'RE OPTIMISTIC THAT
THEIR CARE PROVIDERS ARE
CREATIVE AND ADAPTIVE AT WHAT
THEY'RE DOING, AND JUST TOUCHING
THE SURFACE OF THE POTENTIAL FOR
MUCH DEEPER STUDY AND THOUGHT
ABOUT WHAT'S GENERALIZABLE AND
WHAT'S TRANSPORTABLE, GIVEN HOW
MUCH LAURA HAS WORKED ON THIS, I
DON'T WANT TO GIVE A CHANCE TO
CONTRIBUTE OR THROW IN IDEAS AT
THIS POINT.
BUT I DON'T WANT TO PUT YOU ON
THE SPOT, EITHER.
>> IT'S OKAY, I DON'T HAVE
ANYTHING MORE CONCRETE TO
ANSWER, I MEAN I THINK IT WOULD
BE VERY HELPFUL AS EVERYONE HAS
SAID, IF THEY HAVE THOUGHTS TO
PUT IT IN THE CHAT AND WE KNOW
SOME OF WHAT WE ARE DOING MOVING
FORWARD WITH SOME OF THE NIH
WORKFORCE INITIATIVES AT LEAST
IS THAT WE ARE INCLUDING
PATIENTS IN OUR ADVISORY PANEL,
SAY FOR THE NATIONAL K12 AND FOR
THE R24 TO BE ABLE TO SERVE AS
MENTORS TO THE NEXT GENERATION
OF HANES SCHOLARS AND IT COULD
YOU KNOW BASED ON THIS
INFORMATION HERE WE COULD
INCORPORATE INTO THESE NEW
PROGRAMS THAT WE'RE ABOUT TO
LAUNCH SO I THINK IT'S VERY
TIMELY TO BE HAVING THIS
CONVERSATION THAT'S WHAT WE'RE
THINKING ABOUT THOSE PROGRAMS.
>> GREAT WELL WE HAVE A MINUTE
AND A HALF LEFT, I WOULD LIKE TO
CLOSE WITH A QUESTION TO
DR. CANTO, LOOKING AT ARRAY OF
SYSTEMATIC REVIEWS COMING OUT IS
IT PURLY FANT AS TOW THINK THERE
ARE CONCEPTUALIZATION OF THE
REVIEW ON ALTERNATIVE OR VARIOUS
ASPECTS OF TRAINING PROGRAMS TO
INCREASE WORKFORCE, THAT WOULD
FORCE 1 TO DEFINE A METRIC AT
THE BEGINNING TO GET GOING OR
WOULD IT JUST BE AN EXERCISE IN
FUTILITY.
>> YOU KNOW I'VE BEEN SORT OF
TAKING NOTES HERE, I DON'T THINK
WE HAVE ANYTHING QUITE LIKE
THAT, WE ARE DEFINITELY MOVING
MUCH MORE INTO SYSTEM TOPICS SO
IT'S NOT AN IMPOSSIBLE STRETCH
BUT IT'S DEFINITELY I THINK YOU
PUT YOUR FINGER ON IT DEFINING
THE RIGHT OUTCOMES AND THEN THE
OTHER THINGS THAT COME UP IS
KIND OF THE MODELS, HOW DO YOU
HOW DO YOU PUT THINGS IN BUCKETS
THAT ARE MEANINGFUL WOULD
DEFINITELY BE A CHALLENGE AND TO
TAKE SOMETHING OUT, TO TAKE A
TOPIC LIKE THAT UP, WOULD WOULD
REALLY REQUIRE HAVING A ROBUST
TECHNICAL EXPERT PANEL, YOU KNOW
SUCH AS THE 1 GATHERED HERE I
THINK TO MAKE IT PRODUCTIVE.
>> AND IF I COULD--
>> GO AHEAD.
>> I JUST WANTED TO COMMENT
BECAUSE HAVING TRIED TO DO A
SIMILAR THING WITH VOCATIONAL
REHABILITATION MODELS WHERE
THERE ARE NO PREDEFINED
COMPONENTS AND YOU KNOW YOU HAVE
TO DO THAT, OFTEN THESE PROGRAMS
ARE TAILORED TO THE LOCAL
PROBLEM I. E. THE STATUS OF YOUR
DISCIPLINE, THE STATUS OF YOUR
PARTICULAR WORKFORCE, SO I THINK
WE FOUND IT VERY CHALLENGING TO
DISENTANGLE THE STRUCTURES THAT
WERE CAUSEALLY RESPONSIBILITY
FOR OUTCOMES VERSUS THE FEATURES
THAT WERE DESIGNED TO FIT THE
POPULATION SITUATION THAT THE
PROGRAMS WERE INVENTED FOR.
WELL, THANK YOU AND I WAS JUST
BRINGING THIS UP AS A MEANS TO
STIMULATE DISCUSSION, I DON'T
HAVE A CHECK BOOK AND AM NOT AN
AGENCY, BUT TO GET PEOPLE'S
THOUGHTS ILLICKITIED, AND I
THINK WE'RE OUT OF TIME
ALLOCATED TO THIS SEGMENT SO I'M
HAPPY TO TURN THIS BACK OVER TO
LINDA, WALTER OR BETH AND THANKS
BY THE WAY TO THE PRESENTERS.
>> THANKS A LOT DAN, THANKS TO
YOU AND CHRISTINE AND LAURA AND
JOHN FOR JOINING US, GOOD
DISCUSSION, TELL GIVE US MORE
THINGS TO THINK ABOUT THIS HAS
WE MOVE FORWARD, REALLY TRYING
TO CHANGE WHAT THE WORKFORCE
LOOKS LIKE, BRINGING IN
INNOVATIVE FOLKS AND SORT OF
REALLY DELVE INTO WHAT THEY NEED
TO GET IN AND STAY IN.
SO WE'RE TALKING A LOT ABOUT
GETTING IN TODAY BUT STAYING IN
IS A WHOLE OTHER ISSUE, SO LOTS
TO THINK ABOUT, BUT YOU KNOW I
ALSO THINKING ABOUT HOW DOES
THIS AFFECT THE PATIENTS, THOSE
WHO REALLY MEANT TO GENERATED
FIT THE RESEARCH, SO ALL GOOD
CONVERSATIONS, WE ARE GOING TO
TURN NOW TO BETH DARNALL, AND
CHRISTINE GOERTZ, SO BETH AND
CHRISTINE ON SERVED ON THE
WELCOMER GROUP THAT MADE
RECOMMENDATIONS TO THE CDC AS
THEY REALIZED THE OPIOID
PRESCRIBING GUIDELINE AND I
THINK THE OFFICIAL NAME WAS THE
OPIOID WORK GROUP, IS THAT
CORRECT?
>> YEAH, GREAT.
>> AND SO BETH IS GOING TO GIVE
US SORT OF AN OVERVIEW OF THE
CHANGES AND I THINK IT WOULD BE
REALLY HELPFUL TO SORT OF HEAR
NOW, THAT THE GUIDELINE LINE HAS
BEEN SIGNIFICANTLY REVISED HOW
IT MIGHT ALIGN WITH THE
RECOMMENDATIONS OF THE WORK
GROUP SO BETH, I WILL TURN IT
OVER TO YOU AND CHRISTINE IS
HERE AND WILLING TO JOIN IN,
SHE'S BEEN AWAY SO WE CAUGHT HER
AT THE LAST MOMENT.
>> YEAH, THANK YOU LINDA AND SO
AS LINDA MENTIONED, CHRISTINE
AND I BOTH SERVED ON THE CDC,
OPIOID WORK GROUP AND THAT WAS
FROM 2020 UNTIL 2021, AND I'M
JUST GOING TO BACK UP A LITTLE
BIT AND DESCRIBE A LITTLE BIT
ABOUT OUR ROLE AND THE PROCESS
AND THEN KIND OF GET INTO THE
CONCERNS OF THE OPIOID WORK
GROUPS, THE CHANGES THAT WERE
MADE AND SOME OF THE CONCERNS
THAT REMAIN.
AND I'LL BE OF COURSE BRINGING A
REPORT ASPECT TO THIS AS WELL AS
MY PERSONAL OPINION TO THE
MATTER AND THEN CHRISTINE CAN
CHIME IN WITH HER OBSERVATIONS
AS WELL.
SO, A BIT OF A BACKGROUND AND
FORGIVE ME IF THIS IS ALL SUPER
REPETITIVE FOR EVERYONE BUT AS
MANY OF YOU KNOW THE 2016 CDC
GUIDELINE FOR PRESCRIBING
OPIOIDS WAS LIMITED REALLY TO
PRESCRIBING IN PRIMARY CARE, BUT
NOT MORE BROADLY TO PAIN EXPERTS
AND IT WAS VERY SPECIFIC TO
OPIOIDS, THE GUIDELINE WAS MISS
INTERPRETED AND THIS APPLIED.
THERE WERE--YOU KNOW DOSE
THRESHOLDS THAT WERE MENTIONED
THROUGHOUT THE 2016 GUIDELINE
THAT WERE REALLY TAKEN AS RIGID
RULES AND APPLIED THROUGHOUT
COMMUNITIES, CLINICS,
PRESCRIBERS AND EVEN CODIFIED
INTO STATE LAWS AROUND OPIOID
PRESCRIBING IS HARD LIMITS AND
SO WHAT WE SAW WAS INDIVIDUALS
TAKING THESE NUMBERS,
MISAPPLYING THEM AND THEN ACTING
ON THEM TO RAPIDLY OR LESS
RAPIDLY, BUT STILL TAPER PEOPLE
OFF OF MEDICATIONS REGARDLESS OF
ANYTHING ELSE IN SOME CASES, AND
WHAT WE SAW IN THE INTERVENING
YEARS WAS A STATE OF
PUBLICATIONS DESCRIBING HARMS
NEGATIVE CONSEQUENCES OF THESE
MISSED APPLICATIONS SO IN 2019
THE CDC PUBLISHED A CORRECTION
AND ADMONISHED THESE PRACTICES
THAT WERE OCCURRING BASICALLY
STATING HEY, WE NEVER INTENDED
FOR THIS TO BE THE CASE, THEY
ACKNOWLEDGED THAT THE GUIDELINES
FOR THIS BEING APPLIED
CONTRIBUTING TO POOR OUTCOMES,
OVERDOSES AND EVEN DEATHS IN
SOME CASES.
SO KEY QUESTION THAT WAS BROUGHT
TO THE TABLE WITH THIS BRO POSED
REVISION WAS HOW WOULD THE CDC
PREVENT SUCH HARMS FROM
CONTINUING AND EVEN EXPANDING
WITH THIS NEW DOCUMENT THAT WAS
BEING PROPOSED.
THE CDC OPIOID GROUP WAS
CONVENED WITH 22 MEMBERS AND WE
WERE TASKED WITH REVIEWING THE
ANTICIPATED OPIOID GUIDELINE AND
MAKE RECOMMENDATIONS TO THE
REVISION.
WE CREATED THE GUIDING
PRINCIPLES DOCUMENT TO GUIDE OUR
WORK IN THE WO, GROUP AND THIS
WAS PUBLISHED ON JULY 2nd OF
2021 ALONG WITH OUR FORMAL
REPORT TO THE CDC, OUR FIRST
PINS PAL WAS TO MINIMIZE BIAS,
POTENTIAL BIAS WITH THE EVIDENCE
REVIEWS ISSUES THE AUTHORS OF
THOSE REVIEWS, AND THE STUDIES
THAT WERE EITHER INCLUDED OR
EXCLUDED WITHIN THE REVIEW, WE
WANT TO MINIMIZE BI AS BY
INSURING THE CLINICAL EVIDENCE
AND VARIOUS DATA FROM REAL WORLD
PATIENTS AND REAL WORLD PRACTICE
WAS WAITED APPROPRIATELY WITHIN
THE FRAMEWORK.
A SECOND PRINCIPLE WAS
SCIENTIFIC INTEGRITY TOW REALLY
REVIEW THE EVIDENCE SUPPORTING
NME CLASSIFICATIONS AND OTHER
LATENT FACTORS THAT COULD
DISTORT OUTCOMES FROM PRIMARY
OPIOID SCIENCE, PRINCIPLE 3 WAS
ENHANCING INCLUSIVITY, SO
IDENTIFYING WAYS IN WHICH THE
CURRENT LENS OF THE EVIDENCE
REVIEWS WAS TOO NARROW, AND
THEREFORE EXCLUDING KEY
POPULATIONS.
WE WANTED TO FIND OPPORTUNITIES
TO EXTEND THE LENS TO INSURE
INCLUSIVITY RECOGNIZING THAT
CHRONIC PAIN IS NOT A MONOLITH.
INCLUDES DIVERSE CONDITIONS,
ETIOLOGIES, PAIN TYPES AND
SEVERITYS, WE WANT TO APPRECIATE
THE COMPLEXITY OF CHRONIC PAIN
AND FUNDAMENTALLY RECOGNIZING A
NEED TO PROTECT THE OUTLIERS.
PEOPLE WITH RARE DISEASES,
PROGRESSIVE DEGENERATIVE
CONDIPGZS WHO MAY NOT OTHERWISE
BE CAPTURED IN AESES ISMENTS
THAT SIMPLY AGGREGATE RISK
VERSUS HARM AT A GROUP LEVEL.
PRINCIPLE 4 WAS PATIENT AND
CLINICIAN CENTEREDNESS, SO
RECOGNIZING AND SOME OF THE
TREATMENT RECOMMENDATIONS
WHETHER PHARMAICOLOGGIC OR
NONPHARMAICOLOGGIC OPTIONS WERE
CLINICALLY ACCESSIBLE,
MEANINGFULLY ACCESSIBLE TO THE
INDIVIDUAL AND SIMPLY
RECOGNIZING THAT CITING EFFICACY
EVIDENCE ALONE IS INSUFFICIENT
WITHOUT PLACING THE EFFICACY
EVIDENCE WITHIN THE CONTEXT OF
ACCESSIBILITY.
PRINCIPLE 5 WAS THE HISTORICAL
CONTEXT TO MITIGATE HARMS FROM
UNINTENDED CONSEQUENCES THAT
WERE DOCUMENTED FOLLOWING THE
2016 OPIOID GUIDELINE SO WE
WANTED TO SEE, CDC INCORPORATE
LESSONS LEARNED FROM VARIOUS
MISINTERPRETATIONS OF THE PRIOR
GUIDELINE, AND TO REALLY MAKE
PROVISIONS SO THAT
RECOMMENDATIONS WOULD NOT BE
EASILY DISTORTED IN LANGUAGE AND
SO PART OF THIS CAME DOWN TO A
RECOMMENDATION AND PRINCIPLE
AROUND COMMUNICATION SCIENCE TO
INSURE THAT THE CONCLUSIONS IN
THE GUIDELINE WERE CLEAR WITHOUT
AMBIGUITY, MINIMAL ABILITY TO
DISTORT INFORMATION OR CREATE
MISUNDERSTANDINGS ESPECIALLY AS
IT COULD PERTAIN TO LOCAL STATE
OR NATIONAL POLICY.
SO WE RECEIVED THE DRAFT IN LATE
FEBRUARY OR MARCH OF 2021 AND WE
HAD ABOUT 2, 2 MONTHS AND CHANGE
TO REVIEW THE 200 PAGE DOCUMENT
PROVIDE COMMENTS, MEET SEVERAL
TIMES FOR 1 AND HALF HOUR
MEETINGS TO DISCUSS THE DOCUMENT
ANDAD MITTEDLY THE PROCESS WAS A
BIT DAUNTING BECAUSE THIS
REVISION WAS EXPANDED WITH A
SUBSTANTIAL AMOUNT OF TEXT, THE
GUIDELINE, THE REVISED GUIDELINE
WAS VASTLY LARGER IN SCOPE THAN
THE 2016 VERSION, SO WHEREAS
BEFORE IT WAS REALLY CONTAINED
TO OPIOID PRESCRIBING AND
PRIMARY CARE, THIS REVISION
READS MORE LIKE A PAIN TREATMENT
GUIDELINE, NOT JUST AN OPIOID
PRESCRIBING, LIKE IT EXTENDS OUT
TO OTHER PAIN SPECIALISTS, NOT
JUST PRIMARY CARE, AND SO THIS
IS LARGER IN SCOPE AND IT
CREATES SOME VULNERABILITIES
WHERE IN THIS VOLUME OF TEXT,
THERE IS INCREASED RISK FOR
MISINTERPRETATION, THERE'S AN
EXCLUSION OF CERTAIN PAIN
CONDITIONS, WITHOUT REALLY
PROVIDING AN EVIDENCE BASE SO
CANCER AND SICKLE CELL ARE
EXCLUDED BUT NOT SUFFICIENTLY
JUSTIFIED WHY.
YOU KNOW MY BACKGROUND IS
BEHAVIORIAL HEALTH SO THEY
INCLUDE A LOT OF BEHAVIORIAL
HEALTH EVIDENCE WHICH I LOVE BUT
THIS IS A WHOLE IS A WHOLE
LARGER SWATH OF TEXTING AND
CONTEXT TO CONSIDER.
NEWLY INCLUDED IN THIS GUIDELINE
ARE RECOMMENDATIONS FOR TAPERING
WHICH WERE NOT PRESENT IN THE
PRIOR GUIDELINE AND WHAT I WILL
REVIEW FIRST ARE THE
RECOMMENDATIONS FROM THE OPIOID
WORK GROUP AND THESE ARE ALSO
AVAILABLE ONLINE, PUBLISHED IN
JULY, ON JULY 2.
SO, THERE'S REALLY TOO MUCH TO
READ BUT I'M JUST GOING TO KEY
IN ON A FEW POINTS THAT ARE
PARTICULARLY SALIENT.
SO MANY WORKING GROUP MEMBERS
WERE CONCERNED ABOUT HOW THE
RECOMMENDATION COULD BE
MISAPPLIED LEADING TO POETIC
TEBTIAL HARM, AND METIGATED THIS
BALANCE WHILE PRESERVING THE
BENEFITS OF THE GUIDELINE, MANY
WORK GROUP MEMBERS NOTED HOW THE
GUIDELINE HAS A CONSTANT TENSION
BETWEEN PUBLIC HEALTH VERSUS
INDIVIDUAL PATIENT BENEFIT.
WITH A LACK OF CONTENT RELATED
TO THE UNDERTREATMENT OF PAIN AS
BEING A PRIMARY CONCERN, MANY
GROUP MEMBERS WERE CAUTIOUS
ABOUT INCLUDING SPECIFIC OPIOID
DOSE THRESHOLDS IN THE
RECOMMENDATIONS, WORK GROUP
MEMBERS ACKNOWLEDGED THE
IMPORTANCE OF HAVING BENCHMARKS
THAT SPECIFIC OPIOID DOSES WOULD
BE MISAPPLIED AS ABSOLUTE CUT
OFFS OR THRESHOLDS FOR POLICIES
OR PRACTICES, MANY WORK GROUPS
NOTED EXCEPTIONALISM THROUGHOUT
THE GUIDE LINE, CERTAIN
CONDITIONS WERE NAME INDEED THE
TEXT WHILE OTHERS WERE NOT,
LEADING TO INTERPRETATION
WHETHER CERTAIN PAIN CONDITIONS
WERE REAL OR WORTHY OF CERTAIN
PAIN TREATMENTS.
AND SO THIS APPLIED TO SICKLE
CELL DISEASE, CANCER, PALLIATIVE
CARE, END OF LIFE CARE WHICH
SEEMED TO HAVE SPECIAL
EZIGNATIONED NOT ENJOYED BY
OTHER TYPES OF PAIN CONDITIONS.
SO THIS SORT OF GIVES A LITTLE
BIT OF A FLAVOR OF WHERE WE WERE
COMING FROM IN ALL OF THIS.
SOME AREAS OF THE REVISED
GUIDELINE WERE NONCONTROVERSIAL
SUCH AS USING CAUTION WHEN WHEN
INITIATING OPIOIDS FOR INSTANCE
BUT MANY IF NOT MOST OF THE
OTHER AREAS ENGENDERED A HIGH
DEGREE OF DISCUSSION AND WERE
DIVERGENT OPINIONS SO EXTENSIVE
DEBATE AMONG THE OPIOID GROUP ON
A FEW ITEMS WHICH MAY BE A
REFLECTION OF THE PROCESS ITSELF
WHEREBY PAIN CLINICIANS AND PAIN
SCIENTISTS WERE NOT PART OF THE
AUTHOR TEAM PER SE, SO THE
OPIOID WORK GROUP FOR INSTANCE
WAS AN ADHOC ADVISORY GROUP
COMPRISED OF PAIN RESEARCHERS,
PAIN CLINICIANS ISSUES PATIENT
STAKEHOLDERS, BUT NONE OF US OR
OTHERS WERE PART OF THE PRIMARY
AUTHOR GROUP WHO DETERMINED THE
EVIDENCE GRADE, WHICH STUDIES
WERE INCLUDED IN THE GUIDELINE
WHICH TOPICS WERE INCLUDED IN
THE GUIDELINE, THE SCOPE OF THE
GUIDELINE, SO WE WERE ADVISING
ON A DOCUMENT THAT WAS ALREADY
BAKED ESSENTIALLY BUT THIS
STANDS AS A DEPARTURE FROM HOW
THESE PROCESSES NORMALLY TAKE
PLACE, SO HISTORICALLY AND
NATIONAL LEVEL, GUIDELINES,
THERE'S REALLY A RECOGNITION
THAN A CRITICAL NEED TO INCLUDE
SUBJECT MATTERS IN THE
AUTHORSHIP PROCESS, SO A HIGH
DEGREE OF REPRESENTATION, SO,
I'LL JUST INVOKE THIS, THE
IPRCC.
SO IN PUTTING TOGETHER HHS
NATIONAL PAIN STRATEGY AND YOU
KNOW IMPLEMENTING THAT WHOLE
EFFORT, THROUGH 80 SUBJECT
MATTER EXPERTS INVOLVED IN THE
DRAFTING OF THAT DOCUMENT, SO
IT'S REALLY A CO CREATION
COLLABORATIVE SO THAT WASN'T
WHAT HAPPENED WITH THE CDC
DOCUMENT WHERE THERE FERS A
SMALL NUMBER OF INTERNAL AUTHORS
WHO DEVELOPED THE DOCUMENT SO
THERE WAS A DIVERGENT PROCESS
THAT I PERSONALLY THINK LED TO A
LOT OF THE CONTROVERSIES AND
SOME OF THE DIFFICULTIES OF THE
OPIOID GROUP HAD IN RECONCILING
THE MATERIAL THAT WAS PRESENTED,
RELATIVE TO OUR VARIOUS
STAKEHOLDER OPINIONS WHICH ARE
ALL DIVERGENT, A LOCK OF
INTEGRATION AT THE FRONT OF IT
SO, YES, SO THERE WAS NOT A
FOLLOWING OF STANDARD IN THAT
CASE.
THE OPIOID WORK GROUP PRODUCED
ITS REPORT, I SUMMARIZED A
COUPLE OF THE KEY CRITICISMS AND
THEN THE OPIOID WORK GROUP WAS
IMMEDIATELY SUN SETTED AFTER
ISSUING ITS REPORT.
WHICH I FOUND ODD, MAYBE THAT'S
JUST NATIONAL PROCESS BUT I
THOUGHT THERE SHOULD BE MORE
OVERSIGHT AROUND THE INTEGRATION
OF THE RECOMMENDATIONS INTO THE
FINAL DOCUMENT.
CDC STATED THERE WOULD BE ADHOC
INDIVIDUAL MEMBERS WHO WOULD
PROVIDE THIS OVERSIGHT BUT THAT
WAS NEVER MADE CLEAR TO US AND
AGAIN, YOU KNOW WE WERE SORT OF
SUN SETTED.
I--YOU KNOW I WILL SPEAK FROM MY
AREA OF EXPERTISE WHICH IS
AROUND PRESCRIPTION OPIOID
TAPERING AND I MENTIONED I'M A
PRINCIPLE INVESTIGATOR FOR A
5-STATE NATIONAL TRIAL ON
PATIENT CENTERED OPIOID
TAPERING, THAT INVOLVES, 12
PRIMARY CARE AND PAIN CLINICS
ACROSS THESE 5 STATES AND YOU
KNOW IN 2019, HHS PUBLISHED A
DOCUMENT ON DOSE REDUCTION OF
PRESCRIPTION OPIOIDS AND IT'S
REALLY A FANTASTIC DOCUMENT.
SO AS 1 POINT OF ILLUSTRATION, A
LOT OF--MANY KEY ASPECTS OF THE
TAPERING CONTENT AND THE CDC
PROPOSED REVISION DIAMETRICALLY
OPPOSE THE LANGUAGE THAT'S IN
THE 2019 TO HHS TAPERING
GUIDANCE SO I CAN ALREADY SEE
THE CONFUSION THAT WOULD BE
CREATED HERE, WHAT I WOULD HAVE
LIKED TO HAVE SEEN IS EITHER
THERE WOULD HAVE BEEN
INTEGRATION OF TAPERING OF
EXPERTS INTO THE AUTHORING OF
THIS DOCUMENT WITHOUT OMITTING
KEY SCIENCE WHICH IS THE CASE
NOW OR THE DOCUMENT SIMPLY WOULD
HAVE REFERRED TO THE READER TO
THE EXISTING HHS GUIDANCE ON
TAPERING.
IT ALREADY EXISTS, IT'S
UNAMBIGUOUS, IT'S VERY DIFFICULT
TO MISAPPLY BUT THIS IS A POINT
THAT'S VERY CLOSE TO HOME FOR ME
PERSONALLY AND IT ALSO TOWRCHED
ON THE KEY CONCERN THAT THE DOSE
THRESHOLDS WILL BE MISAPPLIED
AND THE TAPERING CONTENT HAS
BIAS AND IS NOT SCIENTIFICALLY
GROUNDED IN THE WAY THAT THAT T
SHOULD.
SO WHEN LINDA ASKED ME, CAN YOU
TALK ABOUT HOW THE OPIDDOID WORK
GROUP RECOMMENDATIONS WERE
INTEGRATED INTO THE REVISION, I
WOULD SAY, WELL IN SOME CASES
THEY WERE AND HAD IN SOME
CRITICALLY IMPORTANT CASES THE
OPIOID WORK GROUP GUIDANCE WAS
NOT--WAS NOT FOLLOWED OR
INTEGRATED AND MY CONCERN IS
THAT THERE WILL ABSOLUTELY BE
MISSED APPLICATIONS IN THIS
DOCUMENT.
THIS REVISION IS QUITE
CONTROVERSIAL EVEN PUBLICLY,
THERE WAS 1 LETTER SIGNED
PRIMARILY BY PATIENTS BUT OTHER
ORGANIZATIONS FOLLOWING THE
PUBLICATION OF THE PROPOSED
DRAFT DOCUMENT AND THEY GARNERED
35,000 SIGNATURES IN OPPOSITION
OF THIS DRAFT IN I BELIEVE IT
WAS IN ABOUT 3 WEEKS TIME SO I
DON'T KNOW WHAT THE SOLUTION IS,
BUT I'M NOT HERE REALLY TO
PROVIDE SOLUTIONS BUT SIMPLY TO
PROVIDE A REPORT ON YOU KNOW AS
LINDA SAID, HOW WERE THE
RECOMMENDATIONS INTEGRATED, WHAT
ARE THE POTENTIAL DOWN STREAM
CONSEQUENCES OF THIS, WELL, I
THINK WE'VE ALREADY SEEN THAT
OCCUR IN 2016.
I DON'T SEE ANY IMPROVEMENT
AROUND POTENTIAL SAFETY MEASURES
AROUND MISAPPLICATIONS AND IN
FACT, THERE MAY BE MORE IN THIS
CASE BECAUSE OF THE EXPANDED
SCOPE.
SO I WILL STOP THERE, I WILL
TURN IT OVER TO CHRISTINE AND WE
CAN HEAR HER PERSPECTIVE AND
COMMENTS IF SHE HAS ANY TO
SHARE.
>> THANK YOU.
THANK YOU BETH AND THANK YOU FOR
THE OPPORTUNITY TO TALK ABOUT
THIS, THIS IMPORTANT ISSUE.
I THINK THE COMMENTS THAT BETH
MADE JUST ILLUSTRATE WHAT AN
INCREDIBLY DIFFICULT ISSUE THIS
IS AND HOW DIFFICULT THE PROCESS
WAS AND HOW IT'S ALMOST
IMPOSSIBLE TO COME UP WITH A
DOCUMENT THAT REALLY ADDRESSES,A
THAT ADEQUATELY ADDRESSES THIS
ISSUE.
AND 1 OF THE THINGS THAT I
REALLY STRUGGLED WITH THROUGHOUT
THE PROCESS WAS TRYING TO FIND
SOMETHING THAT'S ACTUALLY
USEFUL, CONCRETE ENOUGH TO BE
USEFUL IN SOME WAY BUT IS ALSO
FLEXIBLE ENOUGH TO BE, YOU KNOW
PATIENT CENTERED AND PHYSICIAN
CENTERED IN THE WAY THAT THIS
DOCUMENT NEEDED TO BE AND I'M A
LITTLE BIT MORE HOPEFUL THAN
BETH IS THAT THIS DOCUMENT IS IN
FACT AN IMPROVEMENT OVER THE
2016 GUIDELINES AND I PERSONALLY
FEEL LIKE THERE WAS--THERE WAS
REALLY A STRONG EFFORT TO
INCORPORATE THE MYRIAD OF
OPINIONS OF THE MEMBERS OF THE
OPIOID WORKING GROUP BECAUSE WE
DID ALL COME AT THIS FROM VERY
DIFFERENT PERSPECT SPECTIVES I
VES--PERSPECTIVES AND I
THINK WHEN THEY FIRST STARTED
THIS WOULD BE A COUPLE
CONVERSATIONS AND THEN THEY
WOULD BE ABLE TO MOVE ON BUT IT
BECAME QUICKLY CLEAR THAT A LOT
MORE CONVERSATION WAS GOING NEED
TO HAPPEN AND I THINK WE HAVE
WHAT 7 OR 8 MEETINGS THAT DURING
A PRETTY SHORT PERIOD OF TIME
BUT IT WAS INTENSE AND THERE WAS
DEFINITELY A LOT OF DISCUSSION.
BUT THERE WAS THE TISSUE OF
WHAT'S IN THE GUIDELINE AND THEN
THERE'S THE ISSUE OF HOW IT'S
IMPLEMENTED AND HOW IT'S USED
AND HOW IT'S COMMUNICATED TO
OTHERS I THINK THAT IS--WE WON'T
REALLY BE ABLE TO TELL WHAT
IMPACT THIS WILL HAVE UNTIL WE
SEE HOW THOSE VERY DIFFERENT
COMPONENTS END UP GETTING ROLLED
OUT.
>> [INDISCERNIBLE]
>> I'M SORRY WHAT WAS THAT?
>> I ASKED IF THERE WERE
QUESTIONS FOR EITHER OF YOU FROM
THE GROUP.
>> HAPPY TO ANSWER QUESTIONS.
>> HI, I HAVE 1 QUESTION.
ACTUAL 3 TO BETH, IN YOUR
INTRODUCTION, YOU SAID THAT, YOU
KNOW THE 2016 VERSION, YOU KNOW
WAS--HAD THE VULNERABILITY OF
BEING APPLIED IN TERMS OF DOSING
RECOMMENDATIONS AND FROM WHAT
YOUR REPORT JUST SAID, IT SOUNDS
LIKE MAYBE THE SAME
VULNERABILITY MAY STILL EXIST
BUT NOW THEY'VE ADDED ANOTHER 1
IN TERMS OF TAPERING THAT HAS
THE POTENTIAL OF BEING
MISAPPLIED AND DOSING AND
TAPERING IS THERE A THIRD OR
FOURTH AREA FROM WHAT YOU SAW
THAT HAS KIND OF THE POSSIBILITY
OF BEING CODIFIED OR MISAPPLIED
IN IMPLEMENTATION.
>> YOU'RE MUTED.
>> YEAH, THANKS DAVE, IT'S A
GRIT --GREAT QUESTION.
I THINK THERE'S VULNERABILITIES
EACH STEP OF THE WAY THE EXTENT
TO WHICH IT'S NOT MADE CLEAR
THAT ALL THE INFORMATION
SHOULD--IS GENERAL GUIDELINES
BUT DECISION MAKING IS
CONTEXTUREALLY WEIGHTED AND
GROUNDED WITHIN EACH PERSON'S
UNIQUE SITUATIONS THEIR
DIAGNOSIS, THEIR MEDICAL
CONDITIONS, ET CETERA SO, YOU
KNOW I MENTIONED THE BEHAVIORIAL
HEALTH, THERE'S A LARGE SECTION
AND PSYCHOLOGICAL THERAPIES AND
YOU AND I CAN CELEBRATE THAT
BECAUSE THAT'S SORT OF OUR
BACKGROUND AND WHERE WE FOCUS A
LOT OF OUR RESEARCH BUT MY
CONCERN IS THAT AS YOU AND I
BOTH KNOW THESE TREATMENTS ARE
NOT YET WIDELY AVAILABLE AND SO
TO PUT BEHAVIORIAL HEALTH
FORWARD, AS SOME SORT OF PANACEA
WHEN WE KNOW THAT VERY FEW
PEOPLE GET IT, YOU KNOW FIRST OF
ALL IT'S NOT WIDELY AVAILABLE,
EVEN WHEN PEOPLE GET IT NOT
EVERYONE RESPONDS FAVORABLY, SO
THERE'S VARIABILITY IN RESPONSE
TO THAT, AND EVEN WHEN PEOPLE
RESPOND FAVORABLY TO BEHAVIORIAL
HEALTH, THAT DOES NOT MEAN THAT
IT'S NECESSARILY PROVIDES
SUFFICIENT ANNAL GEEZIA THAT
WOULD OBVIATE ALL PHARMACEUTICAL
APPROACHES AND SO, THERE IS A
BIT OF A REDUCTIVE LENS IN WHICH
THINGS ARE DESCRIBED IN SILOS
WITHOUT A TRULY INTEGRATED WHOLE
PERSON, WHOLE CIRCUMSTANCE
APPROACH AND SO THAT CONCERNS ME
AND THE NEXT PIECE I'LL SAY IS
THAT FOR INSTANCE EVEN AROUND
THE BEHAVIORIAL HEALTH OR AROUND
THE OPIOID TAPERING, THE
SELECTION OF THE EVIDENCE ALSO
COLORS THE MESSAGING AND YOU AND
I BOTH KNOW THAT THE PEOPLE WHO
SHOW UP AND SOME OF THESE
RANDOMIZED TRIALS DO NOT
REPRESENT ALL REAL WORLD
CIRCUMSTANCES.
SO WE HAVE A SELECTION BIAS AND
SOME OF THE RESEARCH AND FORMING
THE CONCLUSIONS OF THE SCIENCE
WHICH FIND THEIR WAY INTO
EVIDENCE GUIDELINES WHICH THEN
INFORM, YOU KNOW THE CDC, OUTPUT
AND SO, YET AGAIN, THERE NEEDS
TO BE MUCH GREATER APPRECIATION
OF THE COMPLEXITY OF THE
PATIENTS THAT WE TREAT, THE
CIRCUMSTANCES THAT OUR
CLINICIANS ARE FACING AND THAT'S
WHERE I THINK THAT THE RICH
TEXTURE OF REALITY MAKES ITS WAY
INTO THE ACTUAL LANGUAGE OF
DOCUMENTS WHEN THOSE TYPES OF
STAKEHOLDERS ARE ACTUAL AUTHORS
AND NOT JUST ADHOC ADVISORS.
>> ANY OTHER QUESTIONS FOR
CHRISTINE?
HAD.
>> I SEE JIM HAS 1, HOW CAN WE
ADVOCATE THAT THE NEW GUIDELINES
WON'T BE MISAPPLIED AND NOT
CORRECTED FOR 3 YEARS LIKE LAST
TIME?
JIM, I THINK IT'S AN EXCELLENT
QUESTION.
AND YOU KNOW WE HAVE A LOT OF
DATA ALREADY ON HOW THINGS CAN
BE MISAPPLIED AND DISTORTION
WITH BE CREATED AND I PERSONALLY
DON'T SEE WITHIN THIS DOCUMENT A
MEANINGFUL IMPROVEMENT TO
CORRECT THAT, WHAT WOULD NEED TO
BE--WHAT WOULD NEED TO OCCUR IS
SOME SORT OF SYSTEM TO MONITOR
FOR MISAPPLICATION OR REPORTING
SYSTEM, RECOMMENDATIONS FOR HOW
TO ADDRESS MISAPPLICATIONS AS
THEY'RE OCCURRING OCCURRING SOF
TRANSPARENCY, NONE OF THAT IS IN
THIS DOCUMENT SO A WAIT AND SEE
APPROACH TO WHAT KIND OF DAMAGE
WILL BE CAUSED YOU KNOW IS VERY
CONCERNING TO ME AND I THINK
THAT HAS TO BE BAKED IN ON THE
FRONT END AND PART OF WHAT
PERPLEXING ME IS IF THE CDC IS
FOCUSING ON PROTECTING PATIENTS
AND PREVENTING SUCH HARMS, WHY
ISN'T THIS BAKED IN ON THE FRONT
END?
AND WHY ISN'T THE HARMS AROUND
TAPERING SUGGESTED?
I CHAL ECIALG PEOPLE TO GO
INTEREST THE GUIDELINE AND FIND
MININGFUL CONTENT ON TAPERING
HARMS, THERE'S ALMOST LIKE A
FOOT NOTE RELATED TO IT, THERE'S
A COMPLETE OMISSION OF SCIENCE
AND MINE WHEEL EVERY WEEK WE SEE
NEW LARGE SCALE STUDIES
PUBLISHING ON HARMS FROM
TAPERING, SUICIDE, OVERDOSE
DEATHS AND FOR SOME REASON
THAT'S GETTING NO TRACTION.
I DON'T UNDERSTAND IT SO YOU ASK
A GREAT QUESTION, JIM.
>> ONE MORE QUESTION IN HERE
FROM
FROM [INDISCERNIBLE] AS TO HOW
THE CDC DECIDES WHAT IS EXCLUDED
FROM THE GUIDELINES AND I THINK
1 IN PARTICULAR WE HAD A LOT OF
INPUT TO US THAT WAS PASSED
ALONG TO THE CDC TO EXCLUDE
SICKLE CELL DISEASE, THIS IS THE
ONLY 1 I CAN SPEAK TO
INDIVIDUALLY BECAUSE THE
COMMUNITY AS I UNDERSTAND IT AT
LEAST WAS FEELING THAT HAVING
SICKLE CELL DISEASE INCLUDED, IT
WASN'T MENTION INDEED THE FIRST
1 BUT IT WASN'T EXCLUDED HAD
RESULTED IN MANY PEOPLE WITH
SICKLE CELL DISEASE BEING CUT
OFF FROM THEIR OPIOID REGIMENS
THEY'VE BEEN USING FOR YEARS.
SOME OTHER--SO IN THIS ITERATION
OF THE GUIDE LINE AND THIS IS
REALLY OUT TO CHRISTINE AND
BETH, THE EXPERTS TO COMMENT ON
THIS?
>> THERE'S EXCLUSIONS AROUND
CANCER AND SICKLE CELL AND
YOU'RE RIGHT, PEOPLE WITH SICKLE
CELL WERE CUT OFF OF THEIR
ANALGESIC REGIMEN BUT FRANKLY
THERE THAT WAS UNIVERSAL ACROSS
PAIN CONDITIONS, SO, SOME SORT
OF SCIENTIFIC AMNESTY FOR 1
GROUP OF PATIENTS AND I'M ALL
FOR PROTECTING PATIENTS BUT IT
NEEDS TO BE GRANTED
SCIENTIFICALLY THE RATIONAL AND
IT WAS NOT--THERE WAS SORT OF AN
ADHOC RATIONAL THAT I HEARD THAT
CANCER AND SICKLE CELL WERE
EXCLUDED BECAUSE GUIDELINES
AROUND THE MANAGEMENT OF OPIOID
PRESCRIBING AND PAIN MANAGEMENT
IN THOSE CONDITIONS ALREADY
EXIST AND CDC WAS DEFERRING TO
THAT, BUT I COULD SAY THE SAME
THING AROUND THE TAPERING
CONTENT.
WELL HHS HAD PERFECT GUIDANCE
AROUND THAT, WHY ARE YOU GOING
IN REENGINEERING IT, BEING
REDACTIVE AND OMITTING SCIENCE
AND CREATING CONFUSION AMONG
CLINICIANS?
SO THERE ARE ASPECTS OF THIS
THAT JUST I CANNOT EXPLAIN AND
ARE NOT LOGICAL.
>> CHRISTINE DID HAVE YOU ANY
COMMENTS AS WE WRAP UP THAT YOU
WOULD LIKE TO SHARE WITH US?
>> I DON'T BEING --THINK I HAVE
REALLY ANYTHING ADDITIONAL TO
ADD.
YOU KNOW REGARDING WHAT
CONDITIONS WERE EXCLUDED, I
THINK THAT THE OVERALL INTENT
WAS TO EXCLUDE 2 CONDITIONS
WHERE THE HARMS HAD BEEN CLEAR
BUT ANYTIME, OBVIOUSLY ANYTIME
YOU MAKE A LIST LIKE THAT, SOME
IMPORTANT THINGS THAT SHOULD
HAVE ALSO BEEN INCLUDED ARE
ELIMINATED AND IT'S--AGAIN, IT'S
A DIFFICULT--THIS IS A VERY
DIFFICULT ISSUE TO PULL TOGETHER
IN SUCH A WAY THAT THE GUIDANCE
IS ACTUALLY SPECIFIC ENOUGH TO
BE USEFUL AND YET BROAD ENOUGH
NOT TO CAUSE UNINTENDED HARMS.
I THINK THAT'S THE--I DON'T
THINK THERE ARE ANY EASY ANSWERS
HERE.
>> SO CAN I ASK IS THERE
ANYTHING THAT IPRCC NEEDS TO DO
FURTHER?
IT SOUNDS LIKE YOU'VE GIVEN
WONDERFUL INPUT AND I COMMEND
YOU FOR THAT OR IS THERE
SOMETHING WE SHOULD BE DOING OR
NOT DOING ACCORDING TO HOW EACH
OF US RESPONDS TO THE CRITIQUE
THAT YOU MASTER EMPLOYLY
ASSEMBLED?
>> WELL, I THINK 1 OF THE ISSUES
WE HAVEN'T TALKED ABOUT MUCH
TODAY BUT THAT WAS SOMETHING
THAT WE TALKED ABOUT QUITE A BIT
AS AN OPIOID WORKING GROUP ARE
HOW DO PEOPLE GET ACCESS TO THE
ALTERNATIVES TO OPIOIDS?
THAT IS--AND I THINK THAT OUR
CURRENT PAYMENT POLICY AND
CURRENT AVAILABILITY OF
ALTERNATIVES IN MANY WAYS EVEN
FOR THOSE FOR WHICH THERE IS
STRONG ENOUGH EVIDENCE THAT THEY
SHOULD BE MORE WIDELY ADOPTED
INTO CLINICAL USE ARE STILL NOT
BROADLY AVAILABLE TO PATIENTS
AND WHATEVER THIS GROUP COULD DO
TO PUSH THAT ISSUE TO THE
FOREFRONT, ARE I THINK IS
INCREDIBLY IMPORTANT.
>> YEAH AND I WILL JUST ADD TO
THAT, YOU KNOW, I SAID IT A FEW
TIMES, DAN, BUT 1 OF MY BIGGEST
CONCERNS AND IT REALLY CAME
THROUGH IN THE TAPERING SECTION,
WAS THE OMISSION OF RELEVANT
STUDIES AND THE SELECTION BIAS
UPON WHICH THE GUIDANCE WAS
BASED.
I FOUND THAT INCREDIBLY
CONCERNING.
IT DOES INVOLVE INTERPRETATION
OF THE SCIENCE INCLUSION, OF THE
SCIENCE AND PAIN RESEARCH, I'M
NOT GOING TO PRETENT TO
UNDERSTAND THE BOUNDARIES,
BETWEEN THE IPRCC AND OTHER
FEDERAL AGENCIES, BUT I WILL
JUST LET THAT SIT WHAT I SAID.
>> BY THE WAY, I NOT ONLY AGREE
WUBUT I THINK IT WAS OUR GROUP
THAT POINTED THAT OUT IN THE
PAPER, IT WAS THE
[INDISCERNIBLE] PAPER, THERE
WERE DIFFERENT STANDARDS BEING
APPLIED FOR DIFFERENT DRUGS
BASED ON INCLUSION BASED ON
DURATION OF DRUG.
>> YES AND I'M JUST SPEAKING OF
THE TAPERING, FOR THE
RECOMMENDATIONS AROUND OPIOID
TAPERING BUT EXCLUDING WHOLE
AREAS OF SCIENCE, EXCLUDING THE
TRUE RISKS ASSOCIATED WITH IT,
AND MOVING FORWARD
RECOMMENDATIONS AROUND TAPERING
IMPLEMENTATION, THAT HAVE BEEN
SHOWN TO CAUSE HARM.
SO, IT IS A LACK OF EVIDENCE, A
LACK OF THE INTEGRATION OF PAIN
RESEARCH AND PAIN SCIENCE THAT I
FIND CONCERNING AND AGAIN, I
DON'T--I DON'T KNOW WHERE THE
BOUNDARIES EXIST BUT IF THERE
WAS SOMETHING THAT COULD COME
OUT OF THIS GROUP, OF COURSE I
WOULD BE HIGHLY INTERESTED IN
THAT, I ALWAYS RECOGNIZE, YOU
KNOW FOR LINDA AND MAYBE WALTER
AND OTHERS THAT THIS IS--IT'S A
POLITICAL HOT POTATO, THAT'S THE
ELEPHANT IN THE ROOM.
YOU KNOW SO, YOU KNOW?
>> I WAS MUTED SORRY ABOUT THAT.
SO THE TAPERING GUIDELINES THAT
ARE OUT IN BETH, THAT YOU FEEL
ARE VER EFFECTIVE IN SCIENCE
SPACE, IS THERE A BETTER WAY OR
A WAY TO GET THAT EFFECTIVELY
OUT TO THE COMMUNITY AS FAR AS
HOW THEY MANAGE IT, I'M SURE
THERE'S BEEN OUTREACH ALREADY
AND NEEDS TO REALLY DISSEMINATE
IT, BUT, HAS THAT BEEN
PARTICULARLY EFFECTIVE.
>> I'M NOT SURE BECAUSE PEOPLE
ARE FOLLOWING THE CDC GUIDANCE
AROUND TAPERING SO, I CAN'T SAY
WITH CERTAINTY AROUND CERTAIN
KEY STAKEHOLDERS ABSOLUTELY.
IT'S A FANTASTIC DOCUMENT,
PUBLISHED IN 2019, THE PROBLEM
OF COURSE IS THAT THIS
REISSUANCE OF THE CDC, THIS
UPDATE IS GOING TO PUT FORWARD
THESE THRESHOLDS WITH A NEW
FORMULA TO TAPER WHICH SUPPLANTS
THE PRIOR GUIDANCE, IT OPPOSES
THE PRIOR GUIDANCE, CREATES
CONFUSION AND IT HAS NONEVIDENCE
BASED RECOMMENDATIONS.
THE ENTIRE SECTION IS MISSING
KEY SWATHS OF LITERATURE SO MY
CONCERN ISN'T JUST ABOUT
PROMOTING THE 2019 AS A VIABLE
DOCUMENT, IS THAT THIS IS ABOUT
TO TORPEDO THAT.
AND THAT WILL--I CAN'T EVEN SAY
IT'S GOING TO BE MISAPPLIED,
IT'S GOING TO BE APPLIED AND
IT'S JUST NOT GOOD CARE.
SO THAT'S WHERE IT IS.
>> WE IS A SYSTEMATIC REVIEW, A
VERY THOROUGH 1 THAT WAS BASED
ON, BUT THE [INDISCERNIBLE]
POSTED IN 1 OF THE FEDERAL
[INDISCERNIBLE] THAT'S AVAILABLE
ON SOME OF THE FEDERAL AGENCY
SITES?
I DON'T KNOW.
>> [INDISCERNIBLE]
>> ELIZABETH DO HAVE YOU
ANYTHING ON THAT?
>> RIGHT THE REBECCA SITE I JUST
PASTED IT IN THE CHAT
PREVIOUSLY, ON THE EFFECT OF
HEALTHCARE WEBSITE IS WHERE ALL
OF THE SYSTEMATIC REVIEWS LIVE.
SO I WILL PASTE THAT AGAIN.
>> ALL RIGHTY.
SO I THINK WE HAVE A FAIR BIT TO
THINK ABOUT AND TO CONSIDER.
IESM NOT QUITE SURE WHERE TO
SUGGEST WHERE THIS PARTICULAR
GROUP HAS A ROLE.
WE STEPPED IN THE PAST
WITHOUT--THERE WAS A BIT OF
CONTROVERSY, LET'S PUT IT THAT
WAY AND AND WE ALL DID HAVE A
CHANCE TO SUBMIT TO THE OPEN
COMMENT AND I BELIEVE THE FINALS
HAVE BEEN RELEASED.
SO, 1 OF THE BIG HOPES NOW IS
THAT THEY'RE NOT MISAPPLIED,
LIKE THE FIRST ROUND WAS ANYBODY
ELSE HAVE ANY NOTES, COMMENTS
ORED WHYS BEFORE WE CLOSE OUT
FOR THE DAY?
WE ARE ACTUALLY AT OUR 4:30
MEETING TIME FINISH.
>> I JUST GOT TEXTED A QUESTION
FROM CINDY STEIN BERG WHO MOST
OF YOU KNOW AND SHE WANTS TO
KNOW IF IT WOULD BE APPROPRIATE
OR POSSIBLE FOR IPRCC TO
COLLECTIVELY WRITE A LETTER
ABOUT THE LACK OF SCIENTIFIC
INTEGRITY IN THE GUIDELINES?
>> SO WE TALKED ABOUT THIS LAST
TIME AND I THINK THAT THE FINAL
RESOLUTION TO THE QUESTION
SIMILAR TO THAT MAGGIE WAS THAT
THE IPRCC MEMBERS WHO ARE
NONFEDERAL CAN CRAFT AND SEND IN
THE LETTER BUT IT WOULDN'T BE
APPROPRIATE FOR IT TO BE SIGNED
UP AS A CHITEE RESOLUTION WITH
CONSENSUS FROM THE AGENCIES THAT
PUTTEDS US IN A FAIRLY AWKWARD
POSITION.
WE WEIGHED IN DURING THE PUBLIC
COMMENT AND DURING THE FEDERAL
PEER REVIEW.
>> AND DOES IPRCC HAVE ANY WAY
OF ENCOURAGING RESEARCHERS OR
PROJECTS INFLUENCING THEM IN
SOME WAY SO THAT THEY INCLUDE
CHRONIC PAIN AS CHRONIC PAIN?
AND INCLUDE THE DIAGNOSIS
ESPECIALLY WHEN THEY'RE
DOCUMENTING THE TAPERING HARMS,
ET CETERA THAT ARE CONSIDERED
RARE OR LESS COMMON?
BECAUSE THAT'S--THAT'S 1 OF THE
THE OBSTACLES FOR PEOPLE GETTING
CARE AND YOU KNOW THAT XLH
PATIENT WHO WAS DENIED, THEY
WERE CUT OFF COMPLETELY,
IMMEDIATELY AND THERE WAS NO
TAPPERRING INVOLVED WHICH
OBVIOUSLY HAD CATASTROPHIC
IMPACTS AND YOU HEAR A SIMILAR
STORY TO CRPS AND DPS AND EVEN
OTHERS RARER CONDITIONS.
>> RIGHT.
>> SO HOW DO WE--ASIDE FROM
GIVING THEM BETH'S E-MAIL
ADDRESS AND ASKING FOR CLEARER
TAPERING GUIDELINES WHAT CAN WE
DO?
>> I DON'T THINK WE WANT TO DO
THAT SO THE IPRCC CERTAINLY CAN
MAKE A RECOMMENDATIONS TO
RESEARCH GAPS THAT THERE ARE,
WHERE THE GAPS ARE AND I THINK,
YOU KNOW 1 OF THE BIG THINGS
THAT HEAL HAS BEEN REALLY
CAREFUL TO INCLUDE IS NOT REALLY
TAPERING STRATEGIES AS PART OF
THE RESEARCH BUT INCLUDING IN
THE CLINICAL STUDIES ON PAIN AND
ON THOSE WITH PAIN AND L. U. T.
OF OPIOID USE AND REDUCTION OF
NEED FOR OPIOIDS BASED ON THE
EFFECTIVENESS OF THE OTHER
INTERVENTIONS THAT THEY'RE
TESTING, SO THERE'S A REAL
SENSITIVITY TO THAT, BUT THESE
ARE NOT, NECESSARILY, WE'RE VERY
CAREFUL NOT TAKING PEOPLE OFF
OPIOIDS AS AN ARM LOOKING AT THE
EXAMPLE OF EEVENGHTIVENESS OF
ANOTHER INTERVENTION SO IT'S
MORE, YOU LOOK AT THE
EFFECTIVENESS OF INTERVENTIONS
AND SEE IF THERE'S REDUCTION IN
OPIOIDS.
SO THAT THERE'S A LITTLE BIT OF
A DIFFERENCE THERE BUT I THINK
THE IPRCC CAN CREATE SOME KIND
OF A DISCUSSION AND MAYBE A
RECOMMENDATION PAPER FOR AREAS
WHERE THEY FEEL THE RESEARCH IS
MISSING FOR WHETHER CERTAIN
CONDITIONS, WHETHER THEY ARE
RARE OR COMMON ARE MORE
SUSCEPTIBLE TO HAVE SUFFERED
FROM THE OPIOID GUIDELINES AND
IT'S HARD TO ASSESS THAT BUT
IT'S CERTAINLY SOMETHING TO BE
CONSIDERED AS A RESEARCH
RECOMMENDATIONS.
[SPEAKING AT ONCE ]
>> I WAS THINKING MORE
PROACTIVELY OF THE TREATMENTS
THAT THEY ARE RESEARCHING THAT
IT WAS EFFECTIVE OR INEFFECTIVE
IN SPECIFIC CONDITIONS BECAUSE 1
OF THE OBSTACLES PEOPLE FACE
THAT THE RARE CONDITIONS ARE THE
LESS 1 KNOWN 1S IS WHEN SOMEBODY
SAYS, WELL WE CAN'T MAKE AN
EXCEPTION BECAUSE WE WERE TOLD
X-WORKS FOR THIS POPULATION OR
THE EVIDENCE, THE RESEARCH
EVIDENCE DOESN'T EXIST TO
SUPPORT EVEN LETTING YOU TRY
THAT SORT OF THING.
SIMILAR TO THE WHOLE
ACCUPUNCTURE IS APPROVED BY CMS
FOR LOW BACK PAIN EVEN THOUGH
EVERYBODY ON THIS CALL KNOWS
THAT IT WORKS ON A THOUSAND
OTHER THINGS AS WELL.
>> YEAH SO THAT WAS A SITUATION
WHERE IT WAS A TIME TO REVERSE
THESE STRATEGIES BUT THERE WAS A
LOT OF STUDIES GOING ON THROUGH
THE INSTITUTES AND THROUGH HEAL
THAT ARE ON SPECIFIC PAIN
CONDITIONS SO SOME ARE
GENERALIZABLE, MORE SKILL-SCALE
OF CHRONIC PAIN OR CHRONIC PAIN
IN GENERAL BUT I THINK FOR THE
MOST PART THEY ARE SPECIFIC
CONDITIONS AND WE OFTEN HEAR
WHEN WE DO OUR PORTFOLIO REVIEWS
OR WHEN THE FEDERAL PAIN
RESEARCH STRATEGY WAS DONE, YOU
ARE MISSING CERTAIN THINGS FOR
CERTAIN CONDITIONS WHERE THERE
IS A HIGH UNMET NEED.
AND I THINK 1 OF THE PROGRAMS
WHEN HEAL WAS ESTABLISHED THERE
WAS A FOCUS ON CONDITIONS WITH
HIGH UNMET NEED, PARTICULARLY
RARE 1S WHERE ANALGESIC
DEVELOPMENT FOR THOSE PARTICULAR
CONDITIONS COULD BE FOCUSED MORE
ON [INDISCERNIBLE].
I DON'T KNOW, WALTER DID YOU
WANT TO WEIGH-IN ON THAT, THE--I
MEAN THIS IS KIND OF
SPECIFICALLY WHERE
[INDISCERNIBLE] EVOLVED FROM THE
HIGH END MET NEED FOR SPECIFIC
CONDITIONS?
>> WELL, I THINK THE QUESTION
WAS MORE ABOUT THESE RARE
CONDITIONS AND SO I DON'T KNOW
THAT THERE'S--MAYBE WE HAVEN'T
PUT THE ATTENTION WE NEED TO IN
THIS SPACE.
I MEAN EPIC NET IS TO DEVELOP
NEW THERAPIES AND CONDITIONS
THAT YOU KNOW ARE BEGGING FOR
BETTER SOLUTIONS BUT THEY'RE NOT
NECESSARILY RARE CONDITIONS SO A
LOT OF [INDISCERNIBLE] PLATFORM,
THAT'S NOT RARE AT ALL, JUST
THAT THE TREATMENTS AREN'T VERY
GOOD.
BUT I THINK IF THAT SEEMS TO BE
AN ISSUE, I THINK WE WANT TO
KIND OF SEND US A LITTLE KIND OF
OUTLINE OF WHAT THE CONDITIONS
ARE, WHAT THE STATE IS, MAYBE WE
CAN MULL IT OVER AND COME UP
WITH A PLAN TO COLLECT EVIDENCE
IN THAT SPACE.
>> MAYBE WE COULD THINK OF THAT
BEING A TOPIC OF DISCUSSION FOR
NEXT WEEK, SINCE WE WILL HAVE
MORE TIME.
>> YEAH, DON'T WAIST.
SEND IT IN.
>> ALL RIGHT.
>> WE WILL TALK ABOUT IT LATER
BUT YEAH.
, YEAH.
>> [SPEAKING AT SAME TIME ]
>> OFF THE TOP OF YOUR HEAD IF
YOU HAD TO NAME THE TOP 3 PAIN
CONDITIONS THAT YOU FEEL ARE
MOST UNDERSERVED WHAT WOULD BE
THEY BE?
>> OH DEFINITELY XLH, CRPS AND
[INDISCERNIBLE] SYNDROME.
>> WE WOULD BE IN AGREEMENT ON
THAT, MAGGIE.
>> OKAY, WELL WE WILL MAYBE POLL
THE GROUP AND THINK ABOUT IDEAS
ALONG THOSE LINES THEN BEFORE
OUR NEXT MEETING.
SO WE CAN WORK THINGS FURTHER
THEN.
SO IF I COULD TURN NOW TO WALTER
FOR CLOSING REMARKS AND HELENE,
AS THEY TRANSITION THE
LEADERSHIP OF THE COMMITTEE.
>> LI SHOULD JUST SAY, IT'S A
GREAT GROUP AND I'M NOT GOING
ANYWHERE AND I'M HAPPY TO WORK
FOR HELENE, SHE'S A GREAT PERSON
AND A GREAT INSTITUTE DIRECTOR.
WE ARE HEARING THINGS THAT
DIDN'T CROSS OUR RADAR SCREEN IN
THE PAST AND THIS IS WHAT THE
IPRCC IS FOR AND AGAIN, I WOULD
JUST EMPHASIZE THAT WITH THE
HEAL INITIATIVE WE HAVE
OPPORTUNITIES TO DO THINGS THAT
WE'RE JUST ASPIRATIONAL AND WE
NEVER THOUGHT BE ABLE TO DO
THEM, YOU KNOW WORKING THROUGH
THE PAIN CONSORTIUM FOR YEARS
BUT NOW WE HAVE THE OPPORTUNITY,
SO, YOU KNOW ALL YOUR WORK, YOU
MAY NOT THINK IT'S GOING TO PAY
OFF BUT CERTAINLY FOR THE PAIN
SPACE IT HAS ALL PAID OFF.
AND SO WE LOOK FORWARD TO
WORKING WITH YOU IN THE FUTURE.
HELENE?
>> SO CLEARLY, AGAIN, --I
APOLOGIZE I HAD TO SKIP PART OF
THIS MEETING I WAS DOUBLE BOOKED
FOR CRAZY REASONS BUT I'M VERY
EXCITED TO BE--TO HAVE THE TIENT
TO CHAIR THIS GROUP GOING
FORWARD.
CLEARLY THIS IS NOT A SHY GROUP
VERY EXCITED ABOUT THAT AND
REALLY WANT TO HEAR FROM YOU ALL
AND I THINK 1 OF THE THINGS THAT
IS THE MOST IMPORTANT AS A
SCIENTIST IS WHEN YOU DO
SCIENCE, IS IDENTIFYING LAUNCH
SPOTS, IESHES DENTIFY AREAS
WHERE WE'RE NOT LOOKING, WHERE
SOMEHOW AND A LOT OF TIME THESE
AREAS ARE IN GAPS IN BETWEEN
THINGS.
AND AT VERY INTERESTING YOU
MENTIONED THE OTHER
[INDISCERNIBLE] BECAUSE THIS IS
AN AREA THAT I THINK HAS BEEN
FALLING BETWEEN IN THE CRACKS,
AND IN FACT, I THINK THAT A LOT
OF THE WORK THAT WE ARE GOING TO
BE DOING ON MY O FACIAL PAIN
WILL GREATLY BENEFIT THE PATIENT
POPULATION BECAUSE THAT PROBABLY
A LOT OF THE KIND OF PAIN THAT
PATIENTS ARE DEALING WITH IS
THEY HAVE CONNECTIVE TISSUE
PROBLEMS, RIGHT?
SO BY DEFINITION.
SO THINGS LIKE THAT, YOU KNOW
WHERE WE CAN SORT OF BE CREATIVE
AND GO LOOK IN BETWEEN THINGS,
AND THEN OF COURSE, THE OTHER
VERY, VERY IMPORTANT THING IS TO
MAKE SURE THAT PATIENTS, WE
THROIIVE WHAT THE PATIENTS ARE
TELLING US AS TO WHAT'S WORKING
FOR THEM, WHAT'S NOT WORKING FOR
THEM, WHERE WHERE ARE THEY BEING
UNDERSERVED AND THIS WHOLE
QUESTION OF OPIOID, YOU KNOW
TAPERING AND IT'S SO, SO VERY
IMPORTANT.
SO, WE REALLY LOOK FORWARD TO
HEARING FROM YOU ALL IN BETWEEN
NOW AND THE NEXT MEETING, WHAT'S
ON YOUR MIND AND WHAT ARE THE
AREAS THAT WE REALLY SHOULD BE
SHINING THE LIGHT ON MORE
BRIGHTLY.
SO, THANK YOU.
>> ALL RIGHT, EVERYBODY, THANK
YOU SO MUCH FOR ALL THE INPUT,
ESPECIALLY TO OUR PRESENTERS,
AND WE WILL SEE YOU ON
OCTOBER 18th.
AT THE NEXT MEETING.
BYE.