Putting children first

After the Great Recession, researchers in pediatric health worried that their field might suffer a permanent loss of funding. That concern faded as U.S. research dollars increased in recent years, but Cliff Bogue, M.D., FW ’93, chair of Yale School of Medicine’s pediatric department, believes even more money should be invested today in child health research. Before and since taking the department’s helm in August 2017, Bogue has traveled to Washington, D.C., to advocate for more pediatric research funding and resources from lawmakers and the National Institutes of Health (NIH). For him, the calculus couldn’t be simpler. “Think of the results a treatment could have on a 5-year-old who lives to 95, versus an 80-year-old who lives 15 more years,” Bogue says.

Recent advances in genetics research suggest that many adult diseases have origins that can be traced to childhood. If more data could be gathered from studies that include children, those relationships could be examined with greater certainty, Bogue said. “One of the next broad themes in pediatric research will be what we call research across the life span,” added Bogue, who has served as chief medical officer of Yale New Haven Children’s Hospital since 2014.

Starting this year, the Yale Center for Clinical Investigation (YCCI) will roll out a pilot funding program on life span research. Researchers from across departments at Yale will be encouraged to gather preliminary data on collaborative projects and use the results to apply for larger NIH grants. Bogue imagines projects that push the edges of medicine. “You could have a geriatrician working with a geneticist to identify biomarkers in Alzheimer’s disease that can be found in childhood,” he says.

Just like his childhood hero, Sherlock Holmes, Bogue thrives on asking the right questions about patient care or a new scientific study. He recalls making his career decision after shadowing a pediatrician as a high schooler in his hometown of Tampa, Florida. Bogue earned his medical degree at the University of Virginia in 1985 and completed his pediatrics residency at Vanderbilt University. He then devoted time to his passion for developmental biology research. After finishing a critical care fellowship at Yale, Bogue joined its faculty in 1993.

Since then, pediatric research has moved at warp speed, Bogue says, especially as genetic sequencing costs have settled to affordable levels. He expects it to continue apace. “Up to 30 percent of patients we see in the pediatric intensive care unit are there because something in their body didn’t form correctly from birth. Most of the time it’s a genetic mutation,” Bogue said.

He sat down with Yale Medicine Magazine to talk more about research across the life span, the single most important activity for young children, and the perils of too much screen time.

What does research across the life span mean? We are finding that a surprising number of diseases have their origins very early in the life span and they may not manifest until years later. If we understand these and can identify them, then we can intervene much earlier. For our YCCI pilot program, the idea is to get groups of people together and started on a project. We want to investigate the biological, environmental, social, and psychological aspects of disease—many of which have their origins in childhood and even prenatally.

What is the single most important thing a parent can do for his or her child? I think we should worry about the increasing amount of time children spend watching a screen, whether it be TV or video games or iPads, and less time spent interacting with others. This constant screen time can actually change the neural networks in the brain. One way to counteract this is through reading and actively playing. If there was a single greatest predictor of how someone will do in life, it is based on how much vocabulary they were exposed to early in life. So much evidence suggests the importance of reading to children at an early age.

What is the most memorable moment of your career? There are quite a few memorable moments. All of them include patient recovery. A year ago, I had visit from a former patient, a young man now in his 20s, who had had a severe head injury. We didn’t think he would do much except be in bed the rest of his life. But he pulled through and went through rehabilitation therapy. He came back to see me because he had just won a gold medal at the Paralympics in Brazil.

What will be your priority as chair? Much of my focus will be what all chairs must focus on, which is being an international leader in research, education, clinical care, innovation, and collaboration. Another thing that is important to me is that our department maintains an environment in which people feel valued and excited to be here. There’s been a lot of discussion in our medical school and at a lot of schools about physician burnout, about the culture, and if clinicians feel valued. I’ve always felt like this department has a personal touch, and that people are its greatest resource. I think that’s important to continue. It’s nice to remember what we are all about: our privilege to care for children and their families. To make lives better. It’s something that most people don’t get to do.

Watch an interview with Clifford Bogue, M.D.