In Reply: The conflicts of interest to which
Dr Lee refers are best left to the individual analyses of institutional review
boards. Participants in clinical trials are not "subjects." They are our patients.
Dr Genel and associates have put a great deal of effort into solutions to
these serious problems, and all of us are very grateful for their productive,
hard work.
Dr Rockey focuses entirely on 1 subset of MD investigators, those who
do translational research from bench to bedside. Since we did not examine
the loss of MD applications during the past 3 years by subset of clinical
research, we cannot confirm or deny Rockey's belief that the loss of applications
is preferential in that group. The 16% decline in MD-PhD applications suggests
that laboratory-based MD investigators share the discomfort of MDs engaged
in clinical trials, outcome analysts, and epidemiologists. To argue, however,
that the new K23 and K24 grant programs will continue to reduce the opportunities
for any particular subset of clinical researchers makes little sense. The
review committees are using the definition of clinical research that our panel
adopted. The new grants should help all clinical investigators to achieve
funding. We hope that the potential beneficiaries of the grants will apply
for them in substantial numbers.