Thursday, March 5, 2009

Do Not Spend the Lion’s Share of the Stimulus Money for NIH on Traditional “RO1” Grants

By Greg Simon, President, FasterCures

There I said it.

You would think we learned that lesson during the doubling of the NIH budget when NIH went farther down the payline without necessarily a commensurate increase in positive outcomes for patients. But apparently not.

In the transition planning for NIH (where I was a part of the Agency Review team) we met with all sorts of groups about NIH’s future. And while there was considerable support from the research community and universities for more RO1 grants, since the NIH budget has declined in real terms for several years, there also was considerable support from patient groups for new approaches to research and training that focused on translational research and new public-private partnerships to help move discoveries toward new and better treatments. So, how to decide?

FasterCures Task Force on the NIH Intramural Research Program (led by Nobel Laureate and FasterCures Board member David Baltimore) noted that the NIH’s world-class research hospital in Bethesda, the Clinical Center, is held back by a dysfunctional funding approach. We proposed a dedicated budget for the Clinical Center, so groups and consortia with the best ideas for clinical trials could perform them there. Meanwhile, other world-class programs such as the Chemical Genomics Center, the Cancer Genome Atlas and caBIG (cancer Bio-Informatics Grid) have demonstrated their potential to radically transform our approach to – and our success in treating – deadly diseases.

But as usual, the battle cry is show me the money – spend it in traditional ways at traditional places for traditional outcomes, which tend to be cautious and incremental. Well, I say, Sow me the money. Let’s sow the future of medicine with the stimulus money, let’s not sprinkle it over the depleted fields of traditional approaches that are no longer the most fertile ground for innovation.
According to Acting NIH Director Ray Kington at a recent briefing at the American Association for the Advancement of Science (AAAS), 8.2 billion of the 10.4 billion dollars will go to the institutes and centers at NIH to spend. They will spend it in three ways:
  • Through R01 and related mechanisms for already approved but unfunded grants. These will be for two years of funding rather than the four that are typical, and projects will need to demonstrate potential for significant scientific advances in two years.
  • Through supplementing existing grants
  • Through new NIH Challenge Grant Programs with areas or "themes" to be identified in concert with the Institutes and Centers. These grants will be $500K/yr for two years, with an expected total yet to be determined but expected to be around $100M-200M.
A modest proposal: of the 8.2 billion dollars allocated to the centers and institutes at NIH, spend only the original 3.2 billion requested in the House bill for RO1 grants and spend the rest on translational awards and challenge grants that support translational and clinical research and researchers. Why? When you fund an RO1 grant, things happen. People hire lab assistants, they buy equipment etc. But when you fund translational programs, more things happen because you can leverage other people’s money. Instead of aiming only to create jobs now, you sow jobs and industries of the future that grow from commercialization of new treatments for disease.

Now, NIH is quick to mention that the money has to be spent in two years and for that, clinical research may suffer. But no one is talking about funding a Framingham study. I’m talking about sequencing more tumors, screening more compounds and doing clinical trials that are ready to go and can be done in two years. If we don’t think anew we can’t renew – and President Obama has made it clear that he is talking about renewing America, not “revisiting” it by doing what we have always done the same way we have always done it.

NIH has to prepare a plan for the stimulus money to submit this month. Those of you who support translational research and have always been told there is no money, listen up. There’s money. Is there a vision? If not, we’ll have no one to blame but ourselves.


Katie Hood said...

Greg, excellent points. While everyone knows that the payline has been devastatingly low this year for R01 grants and for NIH funding generally, the stimulus presents an opportunity to think creatively about reaching for even more significant impact in the next two years. And nothing in my opinion (as you know) is needed more than greater support of translational research.
Thank you for your post.

Scott Santarella said...

Katie, I couldn't agree more. Greg, love sow me the money - during this time of transition and adjustment across all business sectors seeds of change are not only appropriate but essential if we are to ever transform a system that needs to incorporate speed and accountability and deliver clinical results that will impact patients lives today.

John Priestly said...

Greg, you are right on. What is particularly disturbing is that the NIH is trying to eliminate small business grants from their stimulus funding. Fortunately the Senate Small Business Committee is demanding that the NIH reverse course on that strategy. Its time to shift more NIH resourses out of the academic centers into entrepreneurial organizations.

John Priestly