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Providing a strong message backed by a storehouse
of data, NIH director Dr. Elias Zerhouni is touring all of the
institute and center advisory councils this spring, as well as
speaking before a number of scientific societies such as FASEB.
He is on a mission to educate an influential percentage of the
agency's more than 31,000 outside counselors about NIH's current
budget situation: Yes, the budget doubled between 1998 and 2003,
but that created a flood of applications that subsequent relatively
flat budgets could not hope to reward. As the success rate for
competing for an NIH grant dips from a traditional one-third of
all applicants to about 1 in 5, there is discontent and there are
misperceptions that need addressing.
In a presentation he titles, "NIH at the Crossroads: Myths, Realities
and Strategies for the Future," Zerhouni puts things in perspective.
First, the current success-rate pinch is nothing new under the sun.
Much as the business world experiences boom-bust cycles, NIH has
faced disheartening times in the past. Quoting from a gloomy assessment
of high competition for limited funds, and multiple disincentives
to the research enterprise, Zerhouni challenges his audiences to
identify the speaker and his era: it turns out to be former NIH acting
director Dr. William Raub, speaking in 1982.
||NIH director Dr. Elias Zerhouni addresses
the NIA advisory council on May 24. He has been visiting council
meetings and scientific societies.
"This has happened before — in 1982, in the early 1990's
and again now," Zerhouni observed. "History repeats itself. But
NIH is strong, and our response to the current situation suggests
we'll prevail again."
No budget forecaster could have foreseen the "perfect storm" facing
NIH in 2006, he argued: deep federal and trade deficits, rising
expenditures for homeland security, the economic — not to
mention physical — devastation of Hurricane Katrina, preparations
for potential pandemic flu, a 3-5 percent inflation rate in research
costs that is outpacing the general inflation rate and an increased
federal focus on the physical sciences. Added to these factors
is a sense among some legislators that, having doubled NIH's budget,
there's nothing more we really need.
As if this situation were not harsh enough, there are current
myths about NIH's research priorities that Zerhouni took some pains
to puncture: NIH is not emphasizing applied over basic research,
though in 2002 and 2003 — owing mainly to biodefense needs
and infrastructure build-up — there were bulky one-time expenses;
NIH is not shifting toward solicited research (in 1994 about 91
percent of research project grants were unsolicited vs. 9 percent
solicited, and today about 93 percent are unsolicited vs. 7 percent
solicited); and the Roadmap initiative is not some roadhog eating
up 30 to 40 percent of the budget, as Zerhouni has heard some folks
theorize — the real numbers are about 0.8 percent of the
budget in 2005, maxing out at around 1.5 to 1.7 percent next year.
Furthermore, Roadmap expenditures aren't monolithic; in FY 05, there
were more than 345 individual awards (at 133 research institutions),
|Zerhouni shares a light moment at the NIA
advisory council meeting with NIA director Dr. Richard Hodes
"Every great institution needs a little intellectual venture space," he
said, where we can try new things that will benefit the entire
research enterprise, and allow us to take risk for high impact.
Far from having been concocted as a way of draining off R01 investigator-initiated
grants, the Roadmap is largely an acceptance of recommendations
from the Institute of Medicine and more than 300 representative
scientists who contributed their opinions, Zerhouni reminded his
audience. And even within the 1 percent of the budget it claims
("which really wouldn't buy that many more grants," Zerhouni noted),
Roadmap expenses are 40 percent basic research, 40 percent translational
and 20 percent high-risk (e.g., the Director's Pioneer Awards),
the latter of which addresses long-standing concerns that NIH invests
too timidly in research.
|Audience Members React To Director’s Remarks
There are few more critical audiences for an NIH director
than the institute and center advisory councils, and the
scientific societies, each of which is studded with opinionated
members. NIH director Dr. Elias Zerhouni has been earning
high marks with many owing to his frankness. “
||Zerhouni makes a point at the NIA advisory council meeting.
I was impressed by Dr. Zerhouni’s presentation regarding
the current status of NIH, particularly after seeing the
facts regarding the research portfolio, including the funding
of new initiatives balanced with continued R01 support,” said
Dr. Mary J.C. Hendrix, president and scientific director
at Children’s Memorial Research Center, Northwestern
University, who sits on NHGRI’s council. “Furthermore,
I have a better perspective now with regard to the global
reality of our current funding situation and the strategies
for the future. Without question, we scientists need to be
more proactive in expressing our appreciation and need for
continued support of the research enterprise.”
Observed Geoff Duyk, another advisor to NHGRI: “The
director’s presentation provides important context
for understanding the return on investment as well as the
tangible benefits that have been and will be derived from
the support of innovative health care research as a result
of the growth of the NIH budget.”
Said Dr. Peter Spencer of Ohio State University, who serves
on the NIEHS council: “The increase of 40 percent in
the past 5 years in the cost of doing research suggests an
unsustainable enterprise that will demand innovative solution,
including increased outsourcing of research to less expensive
parts of the world. I respectfully suggest this is a very
important topic to debate in some depth at some future time.” He
added, “The Roadmap was billed as 1 percent of the
NIH budget, which is a correct statement, but this is 1 percent
of the overall NIH budget, not the extramural program budget
that university scientists focus on.”
Concluded another NIEHS council member, Dr. David Christiani,
professor of occupational medicine and epidemiology at Harvard
School of Public Health, who is also a professor of medicine
at Harvard Medical School: “[It was an] excellent presentation
by a very competent NIH director and advocate...we are in
tough times, and Dr. Zerhouni discussed how we need to adapt.
We stand to lose our world leadership in biomedical research;
hence, the director needs to advocate,
with our support, for increased support from Congress, even
(especially!) in tough times.”
Zerhouni said there are "three drivers behind the current sense
of pain, and by far the largest ones are capacity-building, and
the increase in tenure-track faculty." The doubling of NIH's budget
prompted a building boom on extramural campuses. The increase in
capacity was an appropriate response to the growing needs of medical
research and public health problems. The difficulty now, however,
Zerhouni pointed out, is that the timing of this boom is no longer
concurrent with the availability of funds.
The issue of congressional appropriations is the second worry
on the minds of NIH and its constituency, and is "a long-term issue," Zerhouni
The third main driver of the current crunch — and the biggest
reason for declining success rates — is the dramatic upsurge
in grant applications: almost the same number arrived in the 2
years following the doubling than occurred during the entire 5-year
doubling process itself. "There is no magic or shadowy manipulation
behind the current crisis — it's just supply and demand.
Basically, the demand for NIH grants took off just as the budget
was coming in for a landing. The two should be taking off together,
Zerhouni is assuring each audience that "we clearly understand
the pain of supply and demand. We want to return to an era of reasonable
success rates. Right now, we are in a period of readjustment." He
also emphasizes that, although getting grants is more competitive
nowadays, many more scientists are receiving funds due to the large
increase in faculty at institutions. "More than 10,500 new applications
arrived in 2005," he reported.
He offered a four-part prescription: know the facts; develop adaptive
strategies (he emphasized the core mission of protecting knowledge
and discovery, increasing the number of competing grants via management
of supply-demand issues, and supporting new investigators through
new programs such as the Pathway to Independence Program, thereby
preserving the future); convey a unified message to the public
at the local, regional and national levels about the benefits of
medical research ("I've been very aggressive recently, and very
explicit," Zerhouni said); and always emphasize NIH's exciting
vision for the future.
"People not only support you for what you did," he explained, "but
also for what they hope you will do."
In the next 15-20 years, he said, the paradigm in medicine will
shift "from a curative approach to a pre-emptive one." He outlined
the "four P's" that will characterize medicine's future: predictive,
personalized, pre-emptive and participatory.
The last fact in his presentation put matters in perspective:
the nation invests $95 per year, per person, on NIH science while
the cost for health care per person each year is $7,000. "Unless
we transform medicine through discovery, the game will be lost," Zerhouni
concluded. "There is no better investment than biomedical research."
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