Inside Salk; Salk Insitute

Insider's View

William Brody

With all the emphasis on cost control by the Congress, the big elephant in the room that has not yet been tamed is the rapid rise of costs for the care of Medicare recipients. Recently I spoke to the vice dean for clinical investigation at Johns Hopkins School of Medicine, and he echoed the sentiment that Medicare patients with five or more chronic ailments are consuming a large fraction of Medicare costs and sapping the energy of the healthcare delivery system.

Patients arrive with a chart outlining multiple problems—diabetes, high blood pressure, heart failure and arthritis, for example—then drop a grocery bag full of medications into the doctor's lap. There simply isn't enough time in the day to sort through which of the patient's problems require focused attention by the doctor and which are not germane to the current visit. The interactions between the myriad drugs are so complex that often it is difficult to separate a problem caused by a drug interaction from one that results from the chronic disease itself. On top of that, the various diseases themselves interact in often unknown ways.

Simply put, we need a far better understanding of the relationships between diseases—and that is where Salk comes in. At the Salk Institute, scientists focus on the basic mechanisms of how cells work in health and disease. Although many of our scientists are exploring the frontiers of specific diseases, such as cancer, Alzheimer's, diabetes and so forth, they also realize that the various pathways by which cells or organs function in one disease may also be active in others. Salk scientists have helped to discover pathways in diabetes that also play a significant role in cancer, for instance, leading to the speculation that one of the most commonly used drugs to treat type 2 diabetes, metformin, may also play a role in reducing the risk of developing certain types of cancers.

The recent award of $42 million from the Leona M. and Harry B. Helmsley Charitable Trust resulted from a free-form discussion among Salk scientists. They considered the similarities among various types of chronic diseases, and postulated that understanding chronic inflammation may be a key to unraveling common pathways underlying these illnesses.

Such an audacious idea is far too risky to be supported by the National Institutes of Health without a lot of data to support the hypothesis. The generous support and keen input from the Helmsley Charitable Trust in developing this grant allows us to bring together scientists at Salk working in different areas, from stem cells to genetics, metabolism to immunology, cancer to neurodegenerative disease. The unique fabric of collaboration without boundaries at Salk, combined with a Helmsley Charitable Trust's willingness to support novel ideas, will make groundbreaking discoveries possible.