The many voices echoed off the historical buildings throughout the streets of Washington, carrying a message of hope and demanding change.

While this scene is one that resonates today, this particular event actually took place more than 25 years ago.

In 1992, the National Breast Cancer Coalition set its first priority: Increase federal appropriations for breast cancer research. Frances M. Visco, coalition president, recently recalled the beginning of the movement that eventually resulted in the formation of Congressionally Directed Medical Research Programs (CDMRP), which have since grown to support over 30 different research areas, such as epilepsy, multiple sclerosis, spinal cord injury and more.

"We launched our $300 million-more campaign and reached out to our grass-roots coalition members across the country," said Visco. "We did letter writing, petition signing, and held lobby days on Capitol Hill, where we brought in women to meet with their senators and representatives. We stood outside committee rooms and on the steps of the Capitol."

In response to this movement, Congress allotted an additional $210 million for breast cancer research. Those funds were directed to DOD, which already maintained the infrastructure with the U.S. Army Medical Command to support this research. DOD delegated the program to the U.S. Army Medical Research and Materiel Command (USAMRMC) because of its history and expertise in medical research and development. USAMRMC created CDMRP to manage breast cancer research as directed by Congress. Thus began the Breast Cancer Research Program (BCRP), the first program of the CDMRP. Nearly three decades after it was created, the latter's focus remains the same: to foster novel approaches to biomedical research in response to the expressed needs of its stakeholders--the American public, the military and Congress.

"The BCRP's strategic approach is to invest in research that addresses the overarching challenges in breast cancer and will lead to breakthroughs toward ending this disease," said Dr. Gayle Vaday, program manager. There is no denying how far breast cancer research has come in the last quarter-century. What once was seen as a dire diagnosis has become one of the most treatable cancers, thanks to successful research.

"Over the years, the BCRP funding has been instrumental in supporting timely, state-of-the-art research that has led to clinical approaches used for patients today, including targeted therapies, like trastuzumab; imaging, such as digital mammography and breast tomosynthesis; and genetic risk assessments like OncoVue and the Breast Cancer Index," Vaday said. The BCRP has also supported more recent trends in cancer immunotherapies and vaccines, as well as cell-cycle inhibitors, and continues to encourage innovative research ideas, she said.

INCORPORATING MANY PERSPECTIVES
Since the Breast Cancer Research Program marked the beginning of the CDMRP, research programs have been modified each year as directed by Congress; the CDMRP is responsible for determining the appropriate strategy and managing the selection process. Currently there are 31 research programs supporting dozens of topics in areas such as cancer, neurological disorders, traumatic injuries and rehabilitative medicine.

The Institute of Medicine (now called the National Academy of Medicine) provided guidance suggesting a two-tier review process. CDMRP adopted this process, which includes both peer and programmatic reviews to guide the funding recommendations. The two-tier process includes participation by consumer advocates who have experienced the program-specific illness, disease or disorder in both reviews, as well as in the development of investment strategies and research focus areas. This has become a hallmark of the CDMRP: developing a unique collaboration in the scientific review process among public and private stakeholders including the military, scientists, clinicians, policymakers, disease survivors, patients, family members and caregivers, providing many different facets of expertise when reviewing research.

Maxwell Ramsey, a consumer reviewer on the Peer Reviewed Orthopedic Research Program (PRORP), learned of the CDMRP through a forwarded email chain from an outreach worker at the Walter Reed National Military Medical Center. "My journey of recovery was not unlike many other amputees at Walter Reed," said Ramsey, who was wounded in action on March 1, 2006. "I made it a point to excel in my recovery so I was [as] highly functional as possible. I remained in the Army for a couple of years after getting out of the hospital--jumping out of planes for the 101st Airborne Division's Parachute Demonstration Team--before retiring from the Army in 2009."

Ramsey had high marks for his experience as a consumer reviewer with the PRORP. "It was excellent. The team is very well-organized, and that makes the process, from initial review to feedback to panel discussion, very smooth," he said. "Personally, I thrive in environments surrounded by hyper-intelligent academics and find the ideas we discuss to be very exciting."

Consumers like Ramsey serve as voting members on nearly all CDMRP peer and programmatic review panels. Invitations to participate on review panels are based on involvement in advocacy, outreach and support organizations, as well as personal experience with the disease or condition under review.

"Consumers add perspective, passion and a sense of urgency, which helps to ensure that the human elements of the disease, disorder or injury are incorporated into program policy, investment strategy and research focus," said Col. Wanda Salzer, CDMRP director.

Dr. Harold Sears is making an impact in the PRORP as well. Sears, a principal investigator, and a commercial research company, Motion Control Inc., have received funding from a PRORP Technology Development Award to work on a new powered wrist and prosthesis system.

"This project was supported by CDMRP to develop a system of practical, highly robust, highly functional prosthetic components for warfighters--and peacekeepers and others in the workforce--who suffer upper limb loss, at any level of amputation," said Sears. "Specifically, the components were intended to meet several important needs of these individuals, to allow the important goals of returning to work or returning to active duty, and expanding the capabilities of their prosthesis, allowing these permanently disabled individuals to expand their activities."

The intent of the PRORP award "was to create practical devices for the injured service member, unlike more esoteric developments which might only be considered 'research,' " he said. A major product, the ETD2 electric hook, has been released into the market successfully, Sears said. When the other projects are completed, they will be offered commercially worldwide by Motion Control.

COMMON DENOMINATOR
While the CDMRP research programs are unique in their topic areas, they all share the common goal of advancing research that will lead to health care solutions, such as disease prevention or cures, improvements in patient care and survival, and breakthrough technologies and resources for clinical benefit. However, the medical needs of the military population are not limited to injuries incurred on the battlefield. The wide range of research efforts funded by CDMRP is the key to maintaining Soldier health on and off the battlefield as well as after service. In addition to supporting those serving in the military, CDMRP also benefits spouses and children in military families.

A recent cutting-edge clinical trial, based on preclinical results funded in part by the Amyotrophic Lateral Sclerosis (ALS) Research Program, has recently begun recruiting patients to see if a combination stem cell and gene therapy will be effective at stalling progression of ALS, also known as Lou Gehrig's disease, an incurable degenerative neurological disorder. Several studies have shown that military veterans, regardless of branch or era of service, are nearly twice as likely to develop ALS as civilians. The trial, funded by the California Institute for Regenerative Medicine, is one of the first to use genetically modified neural progenitor cells to treat a neurodegenerative disease.

CONCLUSION
Medical research is difficult to evaluate, as not every idea is going to be a cure, but each effort could lead to the next. While Visco describes the partnership with DOD as having "truly changed the world of breast cancer," no one could have imagined that the foundation built for one program would expand and evolve into what the CDMRP is today: a life-saving organization that's transforming medical research worldwide for numerous diseases, injuries and conditions.

For more information on CDMRP, go to cdmrp.army.mil or contact the Public Affairs Office at usarmy.detrick.medcom-cdmrp.mbx.cdmrp-public-affairs@mail.mil.

This article will be published in the April -- June 2018 Army AL&T magazine.