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Monica Bertagnolli

It’s not every day that the head of the NIH makes time for Q&A on long COVID and ME/CFS.

An ME/CFS or long-COVID moment is an indication that something in the force has shifted – that these diseases are making headway in ways they have not before. As we go along in our day-to-day lives, it’s easy to forget that signs of significant shifts are occurring – and fairly regularly. Here are some recent ones.

The Bertagnolli Moment

The latest “moment” concerns Betsy Ladyzhets’s Q&A with NIH DIrector Monical Bertagnolli (“Q&A: NIH Director Dr. Monica Bertagnolli on next steps for RECOVER, future Long Covid research plans, and more“.  NIH Directors have a lot on their plates and we rarely see them talk about long COVID, and even rarer, ME/CFS.

THE GIST

  • An ME/CFS or long-COVID moment is an indication that something in the force has shifted – that these diseases are making headway in ways they have not before. As we go along in our day-to-day lives, it’s easy to forget that signs of significant shifts are occurring – and fairly regularly.
  • The latest “moment” concerns Betsy Ladyzhets’s Q&A with NIH Director Monica Bertagnolli (“Q&A: NIH Director Dr. Monica Bertagnolli on next steps for RECOVER, future Long Covid research plans, and more“). NIH Directors have a lot on their plates and we rarely see them talk about long COVID, and even rarer, ME/CFS.
  • Betsy Ladyzhets is an investigative journalist whose main effort, The Sick Times, is a relatively small specialist website; i.e. it’s not the New York Times, the Boston Globe, or even the Cincinnati Herald – and that’s the thing – the new NIH Director took time out of her very busy day to speak to the cofounder of a small website about long COVID and ME/CFS.
  • When asked about the RECOVER Initiative’s much-criticized clinical trials for long COVID, Bertagnolli acknowledged the disappointment, stated that each trial also used the intervention to understand the biology of long COVID, and then pointed to something very unusual for the notoriously closeted RECOVER Initiative – an open meeting from Sept 23-25th to discuss options for the upcoming round of trials. (You must register by Sept 6th.)
  • Citing the “intense activity”, the “really serious, hard work to be done”, and its inclusive nature, Bertagnolli seemed to go out of her way to portray the new RECOVER as a fast-moving, receptive initiative – in short, everything it hasn’t been perceived of as yet.
  • She stated that big Pharma needs to know more about the disease before jumping in but failed to acknowledge that the fact that the $1.15 billion RECOVER Initiative has contributed nothing substantial to our understanding of the disease and doesn’t appear likely to do so anytime soon. (It spent most of its money on a limited testing regimen.)
  • Thus far, RECOVER has proven to be a hugely expensive and decidedly uninformative undertaking. Even with the $500 million boost in funding, Bertagnolli said the initiative is still “struggling with balancing resources”. $1.65 billion hasn’t gone very far…
  • That provides clarity though. The only way ME/CFS and diseases like it will get their fair share is through the Long COVID Moonshot bill that’s making its way through Congress right now. The big push for the bill is coming up soon. Stay tuned.
  • As NIH Director ,Bertagnolli has a stake in seeing the RECOVER Initiative succeed. Right now, its critics abound. The NIH appears to have flubbed the chance to prove it could effectively launch an effort to understand a new disease.
  • She clearly has a lot of work to do. Time will tell whether she will take actions to right the ship or let the project bumble along  Choosing to speak to Ladyzhets suggests, though, Bertagnolli is sincere about long COVID and ME/CFS and that’s potentially a big deal. An NIH director pushing for a long-term commitment to these diseases would, one would think, go far.
  • Words, of course, only account for so much. Former Director Francis Collins told the ME/CFS community that the NIH was now serious about ME/CFS and to watch them, only to drop the disease a year or two later.
  • Time will tell if this is a long-COVID / ME/CFS moment or more talking points from the new Director. I’m hoping that it’s the former.
Vicky Whittemore, the NIH program director for ME/CFS said, though, that Bertagnolli is very aware of ME/CFS and even more so of long COVID. (Vicky also said that the new director of the big immune institute at the NIH (NIAID) is even more interested in ME/CFS.)

Still, why would an interview with Director Bertagnolli be considered an ME/CFS/long-COVID moment? Because of who Betsy Ladyzhets is and who she is not.

Betsy Ladyzhets

Betsy Ladyzhets’s Q&A with Bertagnolli was a good sign.

The cofounder and managing editor of The Sick Times – a journalism-based website documenting the long COVID crisis – Betsy Ladyzhets has been laser-focused on COVID-19 and long COVID. A former journalism fellow at MuckRock, her 2023 STAT/MuckRock piece, “The NIH has poured $1 billion into long Covid research — with little to show for it“, made the news. Her work has appeared in the Science NewsThe AtlanticSTAT News, FiveThirtyEightMIT Technology Review, TIME.com, and other national publications.

For all its good work, Ladyzhets’s main effort, The Sick Times, is a relatively small specialist website; i.e. it’s not the New York Times, the Boston Globe, or even the Cincinnati Herald. That brings up a really interesting question: why would the new Director of the $47 billion-a-year National Institutes of Health take time out of her busy day to talk to her?

The fact that she did do that may be more important than anything she said. When the head of the NIH takes the time to speak to the cofounder of a website devoted to long COVID – that’s potentially very good news.

Bertagnolli’s background doesn’t suggest she would have much interest in complex, poorly understood diseases like long COVID. She’s been immersed in a field – cancer – which with its diagnostic precision couldn’t be more unlike messy fields like long COVID and ME/CFS. (She does know about the Epstein-Barr Virus (EBV), though.)

She has quite a resume. The former Director of the National Cancer Institute (NCI), Bertagnolli was chief of the division of Surgical Oncology for the Dana-Farber Brigham Cancer Center, the former President of the American Society of Clinical Oncology and the chair of the Alliance for Clinical Trials in Oncology. She trained in surgery at Brigham and Women’s Hospital.

She’s not exactly a fresh face. In her mid-60s, she’s had plenty of time to take in the prejudices that have so hampered the ME/CFS field. That doesn’t appear to have happened, though. She became NIH Director not in the middle of the COVID-19 pandemic but of the long COVID “pandemic” and appears to be taking it quite seriously.

The Q and A

Ladyzhets first asked about the RECOVER Initiative’s much lamented first round of clinical trials and the new trials seeded by $500 million from the Biden Administration. First, there was some good news. Bertagnolli pointed out that while the long COVID community was “a little disappointed” (an understatement), each trial also used the intervention to understand the biology of long COVID.

The NIH RECOVER Long-COVID Clinical Trials are Set to Fail: Here’s What Should be Trialed Instead

While some of the interventions were so milquetoast (cognitive training, exercise, sleep hygiene) that one wonders how much help biological analysis will provide others (IVIG, transcranial stimulation, Paxlovid, Modafinil), they might provide some insights. In any case, RECOVER showed some creativity when it decided to dig into the biological effects of the trials.

It became clear that RECOVER got the message about speed as well. In contrast to the “old” RECOVER which kept pushing the starting date of the clinical trials back and back, Bertagnolli said RECOVER was moving “really fast” and pointed to an open Sept 23-25th meeting to discuss the new trials which she called “absolutely critical”. The fact that the meeting is taking place is a rather overt acknowledgment that RECOVER needs more help with creating clinical trials. (That meeting is open to the public and you must register by Sept 6th.)

Citing the “intense activity”, the “really serious, hard work to be done”, and its inclusive nature, Bertagnolli seemed to go out of her way to portray the new RECOVER as a fast-moving, receptive initiative – in short, everything it hasn’t been perceived of as yet.

Recognizing that big Pharma is still mostly standing on the sidelines Bertagnolli noted that until we “understand the fundamental pathobiology” of long COVID, they’re not going to join in. Then she said something that simply didn’t fly: that getting at the pathobiology was a “critical part of the cohorts, the specimens, the clinical trials…” in the RECOVER Initiative.

deep data mining

What happened with getting at the roots of long COVID?

That was ironic given that the single most disappointing aspect of the project has been its rather bizarre neglect of the pathobiology. Bertagnolli was right when she said we need to get at the pathobiology to find the right treatments, but RECOVER has spent most of its money carrying out a limited and hardly informative (at least for the ME/CFS-like subset) testing regimen in tens of thousands of participants.

On the plus side, it’s taking lots of samples. On the minus side, it doesn’t appear to have the funds to do anything with them.

If the RECOVER project has been focused on pathobiology, it’s hidden it very well. Of the 75 publications to come out of the RECOVER project thus far, I found only four that address the pathobiology of the ME/CFS-like subset of long COVID. Somehow, this hugely expensive project has hardly moved the needle in understanding the largest subset found in long COVID.

Since Bertagnolli said a major area RECOVER could improve on was communicating that perhaps there’s something we don’t know. (I’m still having trouble grappling with the idea that such an expensive project has produced so little of substance.)

money wasted

So much money in – so few results out.

Despite the fact that the RECOVER has spent more – much more – on long COVID in five years than it ever spent on ME/CFS over 40 years (and knows much, much less about it), its big problem right now is funding. Bertagnolli said, “Even with the $515 million (boost)…we’re struggling with balancing resources”. $1.65 billion just hasn’t gone very far…

Not surprisingly, Bertagnolli tagged pathogen persistence and an aberrant immune response as the two chief hypotheses regarding long COVID and twice questioned whether we will either need new, stronger antivirals or use the current ones at higher doses.

Thankfully, Ladyzhets kept ME/CFS in the discussion and, in fact, Bertagnolli, without being asked about it, included ME/CFS in her first answer. Still, her reply to Ladyzhets when she talked about people who have had ME/CFS “for 20, 30, 40, years”, while positive, “We absolutely have to address that”, lacked substance.

Bertagnolli acknowledged the need to transition from the shot-in-the-arm type funding given by Congress with the RECOVER Initiative into a “long-term project” that illuminated long COVID “ME/CFS, chronic Lyme disease, all of these chronic conditions.” Her call for “A long-term program that’s really robust in these conditions”, and her support of the Long COVID Moonshot, was encouraging.

When it came to the big question for ME/CFS – what about more funding specifically for ME/CFS –  her reply was typical, disappointing, and illuminating; i.e.

“We care a lot about ME/CFS but don’t look to us for more funding.” Instead, she encouraged the ME/CFS community to pin its hopes on long COVID – which, of course, we are.

“We want to be able to conquer ME/CFS and do it in the best possible way. I hope that the ME/CFS community will see much of the research that’s happening now, spurred on by Long Covid, to benefit them.”

Ironically, we are learning more about ME/CFS from long COVID – but not from the NIH. As to ME/CFS itself, Bertagnolli stated:

“we have a small but mighty team of long-term ME/CFS researchers who’ve been interested in this problem, some internal to NIH, that we intend to continue to fully support… The funding issues, that’s always a moving target. It’s difficult for me to speak to that other than to say, we’re going to do the best we can with what funding we receive.”

The funding “we receive” says it all: the NIH is not going to dig into its coffers to give ME/CFS a hand up. If Congress allocates more money for ME/CFS, fine…otherwise things will remain the same. At least that provides clarity regarding how important the Long COVID Moonshot bill is for both the ME/CFS and the long-COVID fields. Stay tuned on that – a major effort is coming up shortly.

Shooting for the Moon: The $11 Billion Long COVID / ME/CFS / POTS / Lyme Moonshot

As NIH Director Bertagnolli has a stake in seeing the RECOVER Initiative succeed. Right now, its critics abound. The NIH appears to have flubbed the chance to prove it could effectively launch an effort to understand a new disease.

She clearly has a lot of work to do. RECOVER’s open meeting on clinical trials is a step in the right direction, but major issues in the RECOVER program need to be addressed. Whether she will take an active role in addressing them or whether she will let the project bumble along remains to be seen.

A letter from ME/CFS experts to Director Bertagnolli found things looking worse on the ME/CFS front at the NIH. The letter noted that the NIH is dropping funding for one ME/CFS research center leaving only two small research centers to support millions of ME/CFS patients in the U.S. If that wasn’t bad enough, because the remaining center’s funding was not adjusted for inflation they will receive almost 30% less funding than the original centers.

The authors called for ME/CFS patients to be included in the RECOVER cohort, noted that the cohort is not receiving tests that pertain to the ME/CFS-like long COVID cohort, and recommended that RECOVER create an advisory panel comprised of patients, caregivers, and scientific experts with experience in ME/CFS.

Time will tell if this is a long-COVID / ME/CFS moment or more talking points from a new Director. Things aren’t looking good for ME/CFS but I’m hoping for the former.

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