The role of the general clinical research center in promoting patient-oriented research into the mechanisms of disease.

Patient- and proband-oriented research (POR) into the mechanisms of disease has been most successful in the United States over the past 50 years. To foster POR in universities across the country the National Institutes of Health (NIH) instituted 5-year renewable competitive grants for the establishment of General Clinical Research Centers (GCRCs). The number of GCRCs grew from 5 in 1960 to a maximum of 93 in 1969. Currently 74 GCRCs are in operation at 47 of more than 120 medical schools in the United States. They range in size from 4 to 30 beds, with an average of about 10. Each GCRC supports a Program Director, diet kitchens, core laboratory, biostatistical and computing support, nursing staff, and an administrative assistant. The GCRC is available to enable and facilitate POR of faculty investigators based at the parent university. Investigators make applications to the GCRC for support of a given project, the project is evaluated by the GCRC institutional advisory committee and ethics committee, and if found acceptable the resources of the GCRC including bed space, nursing support, laboratory, and statistical capabilities are made available. The GCRC grant supplies the university with overhead support, but more importantly GCRC-supported investigators regularly bring in grant support from NIH far and above that provided by the GCRC grant itself. NIH also provide for research fellowships through the GCRC, including salary support to encourage young physicians to participate in basic POR. These grants are competitive and last for a 3-year funding cycle. The costs of the GCRCs in terms of beds per day are less than those of the Clinical Center at NIH and the overall scientific productivity has been greater. Further, the prestige of having a GCRC and the resources a GCRC provides, have been a major impetus for university support. Despite general problems in terms of recruiting young physicians to careers in basic POR, the GCRC has been a stellar success scientifically, fiscally, and also in facilitating the separation between patient care costs and those engendered by research.