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tect, diagnose, or treat disease—including behavioral and rehabilitation research.

Program project grants can be organized along multidisciplinary lines as well, according to Dr. Reingold whose organization jointly funded a program project grant with NIAID on the concept of gender and autoimmunity.

The real dilemma facing funding agencies, said General Dugan of the National MS Society, is that funding of big projects comes at the expense of more widely distributed investigator-initiated projects. A question he raised was, by what criteria should centers be judged to ensure their productivity?

Dr. Lisak pointed out that some centers funded by the National Cancer Institute are judged not only on the basis of their accomplishments through the center grant but also on other measures of productivity, including success with program projects, investigator-initiated grants, and clinical trials. The Dutch MS Society's recent experience with a multidisciplinary center, said Dr. Lucas, has been highly successful in stimulating more grant applications, publications, and post-docs than would have occurred with separate funding streams.

The VA had been skeptical of the value of a center, noted Dr. Hoffman. But they decided to proceed cautiously with REAPs once they had identified highly focused problems that could only be addressed by some type of center. They plan to perform a careful evaluation of the program according to the criteria developed by the center applicant. “We are willing to partner at the VA ... we are very interested in expanding our funds to expand the whole pool, but we don't want to be duplicative.”

Dr. Reingold commented that centers represent opportunities and risks that might be more palatable if they were shared across funding agencies. Dr. Behar of NINDS questioned whether a center has advantages over a program project. Yet she pointed to the value of a center targeted to a particular problem (e.g., the need for translational research) rather than focused on a particular disease.

When Dr. Behar asked what type of center of excellence is recommended by the workshop, Dr. Hauser replied that there was “one clear need ... for a network of dedicated imaging facilities.” Several participants had highlighted the lack of uniformity or standardization in imaging, which precludes sharing of data, and the need for surrogate markers to assess the progression of MS. Dr. Wolinksy called for four to six regional centers of “imaging excellence” with unlimited use of scanner time and an excellent network to provide “cross-sectional longitudinal data across all subtypes of MS with multimodal imaging that is highly integrated with the occasional pathological correlate.”

Clinical Trials Network

To increase research efficiency (#16), the breakout group supported the establishment of a network of clinical trials with the following goals: to link up clinical investigators, avoid duplication of effort, provide for quality control, clarify diagnoses, and develop standardized measures for clinical trials outcomes. “There was a feeling among the group that this was an idea whose time had come,” said Christine Purdy, the group's rapporteur.

In the discussion, Dr. Wolinsky reported that the Clinical Trials Commit-



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