2025/05/22 by Joshua A. Bloomstone · 1 voice
Health Professions · Psychology · #Compassion #Ethics in medical practice #Law #Political science #Psychology #Sociology
paper · doi:10.1097/01.asm.0001118248.92119.d9
openalex publication_date 2025/05/22 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/23
In the fall of 1987, as my journey in medicine was beginning, my mother, Sheila Bloomstone, may she rest in peace, died from a lethal form of cancer. It was during this period of my life that I gained a profound appreciation and understanding of the significance of research in medicine and the transformative hope it engenders in countless individuals afflicted by debilitating or life-threatening diseases. As I reflect upon my mother's experience, our family's experience, and the experiences of countless other patients and their loved ones – those that I've personally cared for over a three-decade-long career in medicine and those that I will never know – I am reminded of the credo “Primum non nocere” and also what I believe to be an anchoring fundamental in health care: “We or someone we love either is or will be a patient, so the work that we do to support, define, and deliver tomorrow's care today should matter to each and every one of us.” Although my mother's participation in an early personalized monoclonal antibody therapy trial was unsuccessful, subsequent advancements derived from this research have significantly improved the lives of millions of individuals affected by malignancies and other diseases. This incredible life-altering work, and the work that medical researchers do across the globe, not only requires brilliant thinkers and state-of-the-art infrastructure, but substantial private, commercial, and governmental funding, which is ever-dwindling. The Foundation for Anesthesia Education and Research (FAER) is making outstanding progress in this regard, providing funding and mentoring for early-career physician-scientists in their pursuit of research in anesthesiology. Nevertheless, there is much yet to be done. Perioperative morbidity and mortality: A burning platform When I consider the aforementioned anchoring fundamental, and I consider perioperative medicine and surgical outcomes specifically, I am reminded and humbled by the fact that greater than one out of five surgical inpatients across the U.S. and around the globe suffers perioperative complications or adverse events, with 1%-2% of surgical inpatients dying within 30 days of admission. Clearly, enhancing our understanding of the mechanisms leading to adverse outcomes following exposure to anesthetic drugs and the corresponding surgical insults should represent a burning platform for us all. As an anesthesiologist, perioperative physician, and the former corporate chief medical officer of one of America's largest providers of perioperative care, with over 2 million individuals receiving an anesthetic annually, we have an opportunity to drive the discovery of new perioperative knowledge that enhances safety, mitigates risk, drives cost-avoidance (enhanced value), and enhances both patient-empowered care and the experience of receiving care. To this end, philanthropic support for research in perioperative medicine is imperative and offers unique advantages to researchers and hope for patients. Additionally, I strongly believe that philanthropic support for research differs significantly from both commercial and governmental support for the following reasons: Higher risk tolerance: Private funders can support high-risk, high-reward research that may be overlooked by fiscally conservative governments or commercial grant committees. Rapid response: Philanthropic funding can be mobilized swiftly for emerging challenges, as during public health emergencies. Bridging funding gaps: Early-stage research often experiences a “valley of death” between basic science and commercial application, and philanthropy frequently fills this gap. Supporting neglected areas: Philanthropic entities can advocate for and support research in rare diseases or humanitarian challenges that lack commercial market incentives. Freedom from political cycles: Unlike government funding, philanthropic support maintains continuity across political administrations, budget fluctuations, and funding caps. A new imperative for philanthropic research support The NIH is the largest funder of biomedical research in the world, with an annual budget of nearly 48 billion. Recently, a freeze on new grant applications, though temporarily stayed, impacted the distribution of some 1.5 billion in research funding. Additionally, a newly proposed 15% reduction in indirect cost rate allocation, if ratified, will necessitate a comprehensive reimagining of research funding in the U.S. Based on 2023 data, this proposed 15% cap will lower the 9 billion that the NIH spent on indirect costs in 2023 by over 4 billion. While it is hoped that the NIH will reinvest some or all of this money into direct research sponsorship, for now, this roughly 4 billion gap should be filled through philanthropy in order to mitigate lab closures, talent departure, and innovation slowdowns. To this point, it is imperative that we as a society and specialty consider and approach new philanthropic-institutional-research models, including: Dedicated support for existing research-sponsoring foundations Targeted support for early-career investigators to prevent a “lost generation” of researchers Dedicated endowments for research facilities and administrative support, traditionally covered by NIH indirect costs Collaborative funding pools for core research infrastructure across institutions Philanthropic“bridge funding” to maintain laboratory operations during gaps of federal funding Strategic partnerships between government, philanthropy, and industry for sustainable research funding models. Defining and delivering tomorrow's care today – an appeal Since 1986, FAER, a 501(c)(3) nonprofit organization, has awarded over 58 million in research grants and programs at the time this article was written, nurturing our specialty's early-career investigators and contributing significantly to advancements in anesthesiology research and care. Notably, FAER provides a pathway to NIH grant funding for early-career physician-investigators, mentoring them in the rigorous protocols and methods of scientific research. While supporting FAER's mission is always important, support for the Foundation – and other foundations and nonprofit enterprises in medical research – is of paramount importance at this time. Throughout history, philanthropy has been instrumental in fostering transformative discoveries across various scientific disciplines. From the earliest scientific societies to contemporary research institutions, philanthropic contributions have provided the necessary freedom, resources, and visionary leadership to drive groundbreaking advancements. In fields such as perioperative medicine, anesthesiology, surgery, and many others, private donations and funders have accelerated progress that would be inconceivable without their support. The proposed NIH indirect cost cap of 15% represents a fundamental threat to continued scientific progress – one that philanthropy must help address. Without expanded philanthropic engagement, we truly risk undermining decades of progress in our specialty and beyond and ceding leadership in medical innovation to other nations. Amid current global health challenges, philanthropy's role in supporting innovative and creative research has never been more important. By embracing uncertainty, defying market constraints, and prioritizing human needs, philanthropic funding will be indispensable not only for advancing innovation but also for safeguarding the research infrastructure that enables groundbreaking discoveries. The future of medicine – not to mention the innumerable patients whose hope relies on medical progress – depends on it. As a proud FAER sponsor and as a would-be patient, I ask my fellow physicians and anesthesiology's medical practice groups to support FAER today in its quest to define and deliver tomorrow's perioperative care. As you consider both privately supporting and urging your medical group to support FAER, please consider the aforementioned anchoring fundamental.Joshua A. Bloomstone, MD, MSc, FASA, DABA, Former Corporate Chief Medical Officer, Envision Healthcare, Clinical Professor of Anesthesiology, University of Arizona College of Medicine, Phoenix, Arizona, and (Hons) Associate Professor of Surgery, University College London.