How politics trumped peer review at Texas cancer instituteBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7334 (Published 15 November 2012) Cite this as: BMJ 2012;345:e7334
- Charles J Sherr, chair, department of tumor cell biology, St Jude Children’s Research Hospital, Memphis
The Cancer Prevention and Research Institute of Texas (CPRIT), established by a constitutional amendment approved by Texas voters, authorized $3 billion over 10 years “to fund groundbreaking cancer research and prevention” (www.cprit.state.tx.us/about-cprit). A two tiered peer review group organized by chief scientific officer Al Gilman, a Nobel prize winner, included a council of seven members (chaired by an eighth member, Nobel winner Phil Sharp). CPRIT council members led committees that collectively included more than 100 expert cancer biologists, medical scientists, and physicians (all from institutions outside Texas) who were charged with reviewing proposals from Texas investigators.
The council and committee members critiqued a broad spectrum of applications, including individual investigator awards, multiple investigator awards, translational (bench to bedside) initiatives, training grants, pre-clinical and clinical trials, and high risk, early stage drug discovery. Reviewers were urged to apply only a single standard: does the application propose “groundbreaking” research likely to transform our understanding of cancer. In enlisting expert reviewers and leading one such committee (as a non-voting member), I was personally energized by the efforts of my 16 panelists who, without prejudice or conflict of interest, rigorously scrutinized and recommended only the best of the best proposals for funding. All applications under consideration were refereed by at least three panel members, who individually submitted critiques and merit scores that were later made available to the entire committee.
At meetings held twice yearly in Dallas, assembled panelists discussed potentially meritorious applications and voted priority scores, which were used as the basis for recommending funding. Gilman attended these meetings to provide procedural advice but did not participate in the review process or influence my committee’s deliberations. Aside from the grant review process, council members convened by video conferencing at least once a month to consider ancillary CPRIT funding for investigators who were being recruited to various Texas institutions. Medical scientists who participated in these processes frequently commented “this has been the best peer review experience of my career.” I felt that way myself.
In the spring of 2012, there was a sea change. First, council members became aware that certain members of the CPRIT Oversight Committee, which includes nine citizens appointed by the governor, lieutenant governor, and speaker of the house, plus two additional representatives of the attorney general’s and comptroller’s offices, had accused Gilman of directing funds to his previous parent organization, the University of Texas Southwestern Medical Center in Dallas. Some members of the oversight group expressed disappointment that CPRIT funds had not been equally distributed to institutions in their geographical areas, acting in this respect like congressmen who direct “pork” to their districts.
CPRIT also accepted a 6.5 page proposal to fund the Institute for Applied Cancer Science (IACS) at the MD Anderson Cancer Center in Houston. This proposal, described as “commercialization” and requesting $18m (£11m, €14m) for first year operations, was not submitted via the required route or format. The existence of the IACS was not revealed to Gilman or to the Research Review Council, despite its goal: early stage drug development. The brief document mentions no specific drug targets, no lead compounds, no intellectual property, and alludes only vaguely to company based technology development.
The IACS proposal was approved within three weeks of its receipt by the overseers after review by a commercialization panel but without consideration by any members of the established CPRIT research review panels. Given this expenditure, overseers shelved funding of a slate of multiple investigator awards that had been recommended highly by the CPRIT review committees. Gilman’s position, and that of the council, was that the IACS proposal should be resubmitted as a detailed document and subjected to scientific review. In a letter to the overseers, the Council wrote: “The failure to include us in the process calls into question our roles and the integrity of the review program in general. More importantly, this bypass is inherently unfair to every scientist in Texas who participates in the CPRIT program.” Yet, the decision of the overseers that “commercialization incubators” need not be subjected to equal scrutiny triggered Gilman’s announced October departure. Following an ongoing round of grant reviews completed in September, Gilman and CPRIT council members tendered their resignations. All 16 members of my review committee resigned in the following weeks.
In an email inadvertently copied to a member of a CPRIT research review panel, the chairman of the oversight committee, James Mansour, said, “Better to get them all out of the way now. Gives us the prime opportunity to announce a new regime … The headline at the (upcoming) conference will automatically migrate to the new direction for research. Gilman and Sharp and the other resignations will not dominate our conference … Gilman is gone and so is his influence. There will be a number of Texas Institutions who will be ecstatic …We need to take advantage of this opportunity to put a stake in the heart of the past news.”1 In a letter to Mansour, the Texas governor, lieutenant governor, and house speaker state that “It is now time for CPRIT to take further steps to fulfill its statutory mission and expedite innovation that will deliver new cancer treatments to patients within three to five years” 2.
CPRIT now proposes to spend substantially more of its monies on commercialization—perhaps as much as half. To date, CPRIT has funded all company awards that have been recommended by both commercialization and research reviewers with a substantially smaller fraction of available funds. As Gilman and Sharp opined: “Texans deserve to hear the truth about cancer. They must understand that miracles will not happen in a short time. Progress will not be made by those who simply proclaim without explanation that they can do better than hundreds of skillfully staffed and well-financed pharmaceutical and biotechnology companies.” 3 My former CPRIT colleagues and I agree.
Cite this as: BMJ 2012;345:e7334
CJS is chair of the department of tumor cell biology at St Jude Children’s Research Hospital, an investigator of the Howard Hughes Medical Institute, and a member of the US National Academy of Sciences and Institute of Medicine. His personal opinion is not endorsed by any of these organizations.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.