# Presentation: 193970

## NIH at the Crossroads: Myths, Realities and Strategies for the Future

**NIH at the Crossroads: Myths, Realities and Strategies for the Future**
- Elias A. Zerhouni, M.D.
- Director, National Institutes of Health

## NIH Budget Facing a “Perfect Storm” in 2006

- Federal & Trade Deficits
-  Defense and Homeland Security needs
- Katrina
- Pandemic flu
- Post- Doubling effects
- Physical Sciences focus
- Biomedical research inflation- 3 to 5%

## NIH Budget: 

**Myths and Realities...**

## What is Driving Success Rates?

- Is NIH placing more emphasis on applied as opposed to basic science
- Is NIH shifting towards solicited research (RFAs and PAs) at the expense of unsolicited, investigator-initiated research?
- Is it due to the Roadmap?

## Basic and Applied Research

## What is Driving Success Rates?

- Is NIH placing too much emphasis on translational science at the expense of basic research?
- Is NIH shifting towards solicited research (RFAs and PAs) at the expense of unsolicited, investigator-initiated research?
- Is it due to the Roadmap?

## Grants: Unsolicited Far 

**Outnumber Solicited**

## What is Driving Success Rates?

- Is NIH placing too much emphasis on translational science at the expense of basic research?
- Is NIH shifting towards solicited research (RFAs and PAs) at the expense of unsolicited, investigator-initiated research?
- Is it due to the Roadmap?

## NIH Roadmap for Medical Research

**Roadmap**
**0.8%**
**($237 Million)**

**Non-Roadmap**
**99.2%**
**($28,520 Million)**

**FY2005 Request = $28,757M**

- Developed to increase   synergy across NIH
- Not a single initiative but over 345 individual awards in FY05:
-  40% basic
-  40% translational
-  20% high risk

## What Is Really Happening?3 Fundamental Drivers

- Large capacity building throughout U.S. research institutions and increase in number of tenure-track faculty
- Large increase in applicants and applications occurring *after* 2003
- Budgets:
- Appropriations below inflation after 2003 ( +3 % in ‘04, 2.2% in ‘05 and 0% in 06 ) while BRDPI in 2004 was ~ 5%
- Budget cycling phenomenon

**Notes:**
	BRDPI	FY04 (actual) 3.5%	
			FY05 (est.)     3.3%	
			FY06 (est.)     3.2%	
			FY07 (est.)     3.2%

## New Grant Applications  and Success Rates During and After Doubling Period

## As Many New Applicants in the Last 2 years as during the previous 5 years!

## The Budget Cycling Phenomenon:What Funds are Really Available in Any One Year? 

## NIH Congressional Appropriations 

## The Bottom Line: Demand for Grants “Took Off” Just as NIH Budget Was “Landing!” 

- NIH managed well in 2004 and 2005 by shifting “one time” funds from 2003 to 2004, and obtaining small increases in 2004 (2.9%) and 2005 (2%)
- Katrina requirements led to a flat 2006 NIH while rest of HHS underwent a 2.5% cut
- Budget cycling effect will improve demand vs supply of grants in 2007 but *we need to educate public about need for sustainability in research*

##  The Question on Everyone’s Mind:“What are MY chances of being funded?”

- Payline is not the funding cut-off line!
- Success rate per application understates funding rate per applicant
- FY 2005- 22.3% success rate for applications, but 27.6% for applicants
- FY 2006- 19.8% for applications, but ~25% for applicants

## Success Rate is Higher than the Percentile Payline

## Success Rates are always higher for Applicants than for Applications 

- Success Rate files as of May 3, 2006.  Program srf_indiv_060103_rfm
- Individuals are determined using the pi_profile_person_id in IMPAC-II

## Where Do We Go From Here?Adaptive Strategies A Vision for the Future  

## Strategies

- First: Know the facts
- Second: Develop adaptive strategies
- Protect the essential: ***Knowledge and Discovery***
- Increase number of competing grants (supply/demand management)
- Support new investigators
**New Pathway to Independence Program**
**Institutes and Centers efforts to assist new investigators**
- Third: Convey a unified message
- Increase communications about positive impact of NIH at local, regional and national levels
- Fourth: NIH’s exciting vision for the future

## America Is Living Longer And Healthier

**America Is Living Longer ***And Healthier*

- Since 1982, disability rate for elderly Americans declined by 30%
- Improvements in:
- Recovery from heart disease, stroke
- Deafness
- Vision impairment
- Osteoporosis
- Bone and joint health
- New, more effective classes of drugs for arthritis
- Improvements in joint replacement technology

**Notes:**
The disabled spend seven times what the non-disabled do on medical care

The share of people with a stroke, fracture, or other serious condition has 
increased over time.  Rather, reduced disability is because fewer people who have these 
conditions become disabled. 

Progress in disease management, in part due to changes in treatment, may be contributing to reduction in disability

Arthritis improvements: 
disease-modifying antirheumatic drugs
Increased accessibility of nonsteroidal antiinflammatory drugs

## Basic Discovery Today Provides the Foundation for Tomorrow’s Medicine

- Basic Research
- and
-  Technology Development

- Translational
-  Research

- Clinical
- Applications

## The Future Paradigm: Transform Medicine from Curative to Preemptive

**The Future Paradigm: ***Transform Medicine from Curative to Preemptive*

- Preemptive

- Personalized

- Predictive

## NIH

**NIH**

*Transforming medicine through discovery*