Arnold H. Snider
Arnold H. Snider had no connection to the world of spinal cord injury before joining the board of directors of the Reeve Foundation. What he did have, as a veteran of Wall Street for 35 years, was a deep understanding of scientific research investment and an appreciation for strategic problem solving.
"I spent my whole career looking at health care from an investment point of view," said Snider. "I am not a scientist or physician but I had a lot of experience looking at innovation and how it affects markets and companies."
Snider also had experience in nonprofit health research. He and his wife Katherine founded Rheuminations, Inc., a charity that supports research to develop treatments for lupus, a chronic autoimmune disease.
"I'd been retired about three years from running a hedge fund," said Snider. "One of my partners on the fund was on the Reeve Foundation board; basically, he recruited me."
That partner was James O. Welch, Jr. He saw a good fit. "Personally," said Welch, "Arnie and I had a very successful financial relationship. I found him to be an exceptionally capable executive with remarkable people skills. I arranged a lunch in New York to introduce him to Dana Reeve and several key members of the board. We discussed our mission, our success to date and the enormous opportunity for even greater progress towards finding a cure in the years ahead."
Snider jumped in, ascended a steep learning curve and now, as a Vice Chair of the board, heads the research planning subcommittee.
He has added tremendously to the board, said Reeve Foundation Executive VP for Research Susan Howley. "His experience with lupus has been invaluable. He appreciates the difficulties inherent in setting up research networks and he has a real understanding of changing the Lone Ranger culture that oftentimes prevails at the bench. Moreover, his counsel to the Foundation is also informed by the realities of the marketplace. The board and our donors can have a comfort level that Arnie has the knowledge and perspective to insure Reeve Foundation funds are wisely invested."
Welch concurs: "Arnie's decision to join our board is probably my greatest contribution to the Reeve Foundation."
Snider recently visited with Reeve Foundation staffer Sam Maddox to discuss the Reeve science portfolio, the strategy for using stem cells as research tools, and of the great potential ahead.
Q. When you came on the board five years ago, was the state of spinal cord research different than you expected?
A. I did come with some biases. One, I expected to find that the spinal cord field was not as well organized as it is. I came to appreciate that Reeve is probably the only foundation that really tries to address every facet of the problem, from biology to surgery to rehab. It's unique in that respect.
The patient population is more complicated than I appreciated initially. Spinal cord injury isn't homogeneous; it's myriad 'diseases,' if you will, depending on the timing, level and kind of injury. Plus there is the whole panoply of secondary effects related to trauma.
Third, I thought it was premature to build a clinical trial network ahead of any real drugs to test. I have changed my mind on that.
Also, I was skeptical about the Consortium and the efforts to encourage collaboration. With my background in the lupus area I was skeptical you could ever get academics to work together. But the Reeve Consortium, in the almost 15 years it has operated, has been probably the best example of collaboration amongst academics that I know of. I think everyone in the SCI field realizes no single lab has enough firepower to make a real difference.
The Consortium is an extraordinary group of people with valuable long-term chemistries. You go to their meetings and it hits you: How else could you ever discover treatments for spinal cord injury unless you get people like this together?
Q. The Consortium is one part; the individual grants program is another. What balance does the board seek?
A. I'd like to see a fairly even portfolio between the Consortium and grants to individual investigators. This where the out-of-the-box type thinking occurs. We encourage investigators with bright ideas with seed money that may lead to greater support from NIH down the road. But the value of the grants program is only as good as the peer review it gets. You can waste a whole lot of money quickly if you don't have the best people in the field reviewing applications. Really, if people are looking to give money, they should look closely at who is on the science review committee.
Q. You never met Christopher Reeve and had no link to SCI. What motivated you?
A. What hooked me personally was seeing paralyzed individuals, often injured as a result of a traumatic accident. Their minds are perfectly intact, but they are trapped in bodies that don't function the way they should. In my view it's just one of the most horrendous things that can happen to a person.
And you look at the spinal cord...the lesion is such a relatively small space. The peripheral nervous system can repair itself but the brain and spinal cord cannot. In all the experiments over the years, no one has been able to get the axons to cross the scar and grow to the other side of the space. But in our day and age, repair ought to be so simple. That was part of what turned me on. There just has to be a way to do this.
Q. You said you changed your mind about the North American Clinical Trials Network. Why is that?
A. NACTN is important to test new drugs but it's more than that -- NACTN is in fact establishing a continuum of care in acute spinal cord injury. First, the surgeons in the NACTN group are establishing the surgical standards of care -- early decompression and stabilization. The NACTN group is also developing a data registry of acutely injured patients so we can chart the normal course of recovery, something we don't even understand at this point in time. What this means is that eventually, if a person gets the right surgery, plus the right therapies, and then goes on to get the right rehab -- this person has a chance to get back to a reasonably functional state.
Q. A strategy for early intervention?
A. It would be nice if we could cure spinal cord injury by regenerating the lost nerve cells, but we all know that's going to be a long haul. Speaking for myself, I would like to see the Foundation put a lot of emphasis on surgical interventions and getting people into the right rehab programs. What the data clearly show is that intense rehab is good for everybody. No matter what stage they are at.
Of course there are a lot more people with chronic SCI and we must remember them. Those injured more recently may still have a lot of hope we'll find something. Those many years post-injury probably don't look at recovery the same way. The real thing people who've been paralyzed a long time worry about is how they can best manage the aging process. They've learned how to deal with being paralyzed, the day-to-day stuff. But they ask, what will aging mean to my health and function? The Foundation is planning to explore issues of aging with SCI. We need to focus on helping people with autonomic problems, with bowel and bladder issues, and pain. These are such a big part of living with paralysis. By design, we must allocate funding to strategically address these health and quality of life challenges.
Q. The NeuroRecovery Network has had some success with older injuries...
A. If you look at what the Foundation has accomplished, the value of aggressive rehabilitation has to be at the top of the list. It's the crown jewel -- people should have a lot of hope about it. We've got something now that will get people back to a more reasonable standard of living. With the data coming out of the NRN, activity-based recovery and locomotor training should be the standard of care.
Q. What is the Reeve Foundation stem cell strategy going forward?
A. The Reeve Foundation is already known for its support of stem cell research. While so many focus on transplanting stem cells, we wanted to know what we could do now to best facilitate the use of stem cells in injury and repair. Frankly, I'm not hugely optimistic about using stem cell transplants for SCI therapy in the short run. Putting one cell, or group of stem cells, into the lesion area is not going to do much. There are so many types of cells disrupted by trauma. Stem cell treatments will likely require immune suppression. Timing will be an issue, as will infectious complications. So much remains unknown about these cells and their capacity for repair, but also their potential to do harm.
We decided to develop stem cells as a research tool. We now have the ability to grow human stem cells in a straightforward way -- we can make all sorts of neuronal cells. It's an unlimited process.
This technique has the potential to dramatically change the field of preclinical research in spinal cord injury. It allows the research community to move beyond animal models only as the basis of preclinical research. We are dealing with real human cells and it is now possible to use these cells in ways that could not have been imagined not long ago. One could put motor neurons in a dish with muscle cells and study how connections are formed. Or cut an axon and study in real-time the physical and biochemical changes. Combinations of neuronal cells may be developed as assays against which it is possible to screen therapeutic molecules. The possibilities are almost infinite, and the good news is that this technology is here now. We don't have to wait for long-term studies or lengthy regulatory processes. An orchestrated program using some of these novel approaches is now underway in our Research Consortium, lead by Rusty Gage and Sam Pfaff, both at The Salk Institute.
Q. So people may need to adjust their expectations about stem cells....
A. I am not bearish on the transplantation technology. I see this avenue of research as a 10 to 15 year pursuit.
So many parents, spouses, friends of those who are newly injured are frantic to find the state-of-the-art for their loved ones. You find, though, that the state-of-the-art is not as far along as you had hoped it would be. That's a realization most people come to after a while, and it's a hard one to accept.
Q. Some people are not going to wait; they're going abroad for stem cells...
A. In my view going overseas is highly dangerous, and it's highly likely that these off-shore interventions are not going to work. The technology is not far enough along to have much confidence in it. For people who just had an injury, psychologically it must be so overwhelming. We are totally sympathetic to the desperation that loved ones must feel in this situation and, for that reason, the Reeve Foundation feels an extreme sense of urgency to get to effective therapies as soon as possible.