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From: The Rheumatologist, November 2011

Cuts to NIH Funding Affect Programs and Careers

Medical schools tap philanthropic organizatinos and the VA for research dollars

by Kathy Holliman, MEd

Potentially large cuts in National Institutes of Health (NIH) funding are driving a search for alternative sources of research and training dollars, intensifying the need for near perfection in grant applications, and may be driving some young physician scientists away from careers in research.

“We have already seen severe cutbacks in NIH funding in the last few years, and it is probably at the worst I have seen since I’ve been in research,” says Keith Elkon, MD, head of the division of rheumatology at the University of Washington School of Medicine in Seattle. “The idea that this funding will go down even more is devastating. We are already witnessing around 90% of grants being rejected, so our ability to do cutting-edge research with reduced budgets falls precipitously.”

Cuts were made in the NIH budget earlier this year, but a much more drastic cut is possible. The “supercommittee” in Congress must trim about $1.5 trillion from the federal budget by the end of the year or automatic cuts will occur, meaning a 7.9% decrease in the NIH budget. That would be the largest cut in NIH history—about $2.5 billion.

In August, the Ad Hoc Group for Medical Research, a coalition of 214 patient and voluntary health groups, medical and scientific societies (including the ACR), and academic and research organizations, urged Congress to uphold the longstanding tradition of bipartisan support of the NIH.

Given the current uncertainty about future funding, as well as the $260-million decrease in the NIH budget earlier in the year, rheumatology departments at academic medical centers are thinking creatively to save their research programs and support training programs that are essential to their mission.

Finding Funds Elsewhere

S. Louis Bridges, MD, PhD, director of the division of clinical immunology and rheumatology at the University of Alabama at Birmingham (UAB) School of Medicine, says it is an unprecedented time in academic medicine. He describes his division as being “crunched on all levels” due to cutbacks in state support, the drop in philanthropic dollars, tight NIH paylines, and rollbacks in reimbursements for clinical services. Finding sources for bridge funding has become essential for investigators who may have to go through several grant resubmissions to continue with funding for their ongoing research. Investigators at academic institutions throughout the country, including UAB, are seeking research support from traditional sources such as NIH and the Veterans Administration (VA), but are also trying to identify new means of support through philanthropic organizations and industry.

“We are trying to look at all possible sources of funding to maintain our research,” Dr. Bridges says. “We try to make sure that we have sufficient funds for a rainy-day approach because it is raining out there with the current economic situation.”

VA funding of research grants has been a “godsend” at Baylor College of Medicine in Houston, Texas, according to David B. Corry, MD, chief of the section of immunology, allergy, and rheumatology. At Baylor, faculty members are encouraged to consider developing their career within the context of the VA system because of the strength of the VA research program. “It doubles their chances of getting a grant by applying to both the VA and the NIH,” Dr. Corry says.

Young investigators and faculty also should apply to private agencies and institutions for funding. The Biology of Inflammation Center, which Dr. Corry directs at Baylor, is raising funds through private philanthropy to support rheumatology research. “Increasingly, the research centers, regardless of the discipline, are going to have to be very aggressive to make up what looks to be a very long-term shortfall of funding through the NIH. We are very aggressively seeking to build our war chest.”

The University of Washington last year partnered with a private biotechnology company, Resolve Therapeutics, LLC, that is also helping rheumatology research within the division weather a time of dwindling federal dollars for research. The company and the university are working on development of a compound called RSVL-125, a potential treatment for lupus that Dr. Elkon and Jeffrey Ledbetter, PhD, a research professor at the University of Washington School of Medicine, created in their laboratories. “That [partnership] has been a lifeline for us, getting us to where we have continued resources to do research,” Dr. Elkon says.

The ACR Research and Education Foundation also funds a variety of rheumatology research and training efforts through its grants and awards program, including bridge funding for investigators applying for NIH or VA grants, career development grants, fellowship awards, and funding for rheumatoid arthritis research, among others.

Sharon L. Kolasinski, MD, is head of the division of rheumatology at Cooper Medical School of Rowan University, a new medical school in Camden, N.J., that will open its doors to its first class in 2012. Uncertainty about NIH funding is a “huge concern,” and young investigators will be encouraged to start applying for grants “from the day we open our doors,” Dr. Kolasinski says. Cutbacks in NIH funding mean that her department, like those of her colleagues around the country, will need to seek support from foundations and nonprofit organizations as well as partnerships with the pharmaceutical industry, she says.

Striving for the Perfect Grant Application

According to the NIH Office of Extramural Research, “budget concerns have resulted in no specific changes in the processes used by the NIH for approving applications or making funding decisions.” However, investigators and faculty understand that with fewer funding dollars and fewer Requests for Applications (RFAs) being issued by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), grant applications will need to approach perfection to be successful.

“If you have any kind of major weakness in the grant, you will be dinged by the reviewers,” Dr. Bridges explains. “It’s almost to the point that you cannot have any shortcomings in the application at all. You must have everything nailed down or you are not going to score well because it is such a competitive environment.”

Investigators and faculty seeking NIH grants should expect some applications to be rejected. “Almost no one gets a grant now the first time around at the NIH,” Dr. Corry advises. “Our advice to all faculty is that you must continually write grants these days, at least three to four grants a year to the NIH, to the VA, to private groups. You must be continuously focused on writing grants to support your efforts.” He encourages all researchers to scour the NIH website that lists Requests for Proposals (RFPs) and “look for any opportunities that may fall within their particular domains.”

Some research topics may be more favorably viewed by the NIH, such as those dealing with genetics, biomarkers for clinical response, the Patient Reported Outcomes Measurement Information System (PROMIS) initiative, and other patient-reported outcome projects, according to Dr. Bridges. Research in particular niches that provide collaborative opportunities with other investigators is also seen as a strength, such as the rich database of information at his institution on immunological diseases, rheumatoid arthritis, lupus, osteoporosis, and gout, and the availability of a unique population—African Americans.

Funding applications for basic science may not score as well in the current economic climate, Dr. Kolasinski says. “We are seeing a trend in recent years for more emphasis on translational work and a heavier emphasis on the bench-to-bedside formula.”

Renewal of training grants has also become more competitive, with significant cutbacks reported for many programs, according to Dr. Elkon. “Many of the top programs have had to go in a couple of times to get training grants refunded,” he notes. “It has been a double blow to departments. We have a hard time convincing fellows to try basic research and then when they do, there are concerns about continued funding from training grants.”

A Career Choice

Encouraging young physician scientists to choose a career in academic medicine and research has become more difficult in a time of budget cutbacks at the NIH. The onerous task of winning funding in a highly competitive application process, coupled with the debt burden following medical school, is prompting would-be researchers to seek more lucrative opportunities elsewhere, such as in private practice or in industry.

“The number of bench physician scientists in rheumatology continues to dwindle,” Dr. Elkon explains. “Some have been snapped up by industry, where they are often lured away from academia by better salaries. Some young investigators feel that it is going to be such a hard road ahead that they are not willing to try it.”

Currently, the only people who go into research are those “who just can’t live without doing research, who are so in love with research that they will tolerate anything,” Dr. Corry says. He had planned to convert the fellowship program from clinical training to one more concentrated on research, but that plan has been put on hold. “I have had to second-guess myself in this current climate because, ethically, I don’t know if it’s even fair to be encouraging someone to go into a field where only the very strongest will survive. I don’t want to set up anybody for failure, so I’m not pushing as strongly as I would like for career researchers at this point.”

Instead, he is waiting to see if his program’s NIH training grant is renewed next year and whether the NIH budget outlook improves over the next couple of year before he starts actively recruiting for research trainees.

The uncertainty of future funding has other ramifications as well. “The thought leaders should consider what the future of rheumatology will be like if we don’t have a new cadre of investigators,” Dr. Elkon says. “If major teaching institutions are not involved in research and in advancing medical therapies, essentially we stop where we are. It could change the whole face of American medicine if we don’t think new, think different, and improve treatments. We can only do all of that by engaging and supporting our younger people.”

Although times are difficult for programs relying on research dollars, Dr. Bridges remains optimistic about the future. “I view this as a pendulum that is now on one side, but I am totally convinced that it will swing to the other side. We will survive this, and in a few years we will be stronger.”

Kathy Holliman is a medical journalist based in New Jersey.


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