# Presentation: 259902

## 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

## 	Competition for funds from the NIH and other sponsors, intensifying year by year, now stands at an unprecedented level, and shows no sign of abating. Never before have so many established investigators faced so much uncertainty about their longevity as active scientists. Never before have so many novices faced so many disincentives to entering or continuing a research career.

- Dr. William F. Raub, NIH Associate Director for Research and Training, strategy paper, 1982

## 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

- 56.6%

- 53.9%

- 55.2%

- 56.4%

- 52.1%

- 53.0%

- 55.2%

- 55.8%

- 55.2%

- 56.1%

- 40.5%

- 39.2%

- 38.4%

- 38.5%

- 39.8%

- 40.8%

- 43.5%

- 41.0%

- 41.0%

- 40.8%

- 5.0%

- 7.0%

- 3.7%

- 5.7%

- 5.5%

- 5.2%

- 4.8%

- 3.6%

- 3.1%

- 3.1%

- 0.0%

- 10.0%

- 20.0%

- 30.0%

- 40.0%

- 50.0%

- 60.0%

- FY 1998

- FY 1999

- FY 2000

- FY  2001

- FY 2002

- FY 2003

- FY 2004

- FY 2005

- FY 2006

- FY 2007

**Basic Research**

**Applied Research**

**Other**

**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?

## 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 FY 2005:
-  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
- Appropriations below inflation after 2003
- Increases of +3 % in ‘04, 2.2% in ‘05 and 0% in 06
- Biomedical Inflation 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

**Success Rates**

**Applications**

**Projected**

- Number of Applications

- % Success Rate of Grants Funded

**31%**

**19%**

**0%**

**5%**

**10%**

**15%**

**20%**

**25%**

**30%**

**35%**

- 1998

- 1999

- 2000

- 2001

- 2002

- 2003

- 2004

- 2005

- 2006

- 2007

**0**

**10,000**

**20,000**

**30,000**

**40,000**

**50,000**

**60,000**

- 22%

- 49,656

- 43,069

- 24,154

## As Many Applicants in Past 2 Years as During Previous 5 Years!

- 		     ≈

- 26583 - 21249

- (2003) – (1999)

*Period of doubling*

- 5334

- 31791 - 26583

- (2005) – (2003)

- 5208

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

**NIH Appropriations**

- Committed Funds

- Uncommitted Funds

- Budget Increase

- From ending grants
- started 4-5 years ago

- From current year to
- previous year

- Continuing grants

## NIH Congressional Appropriations 

**Billions of Dollars**

**DOUBLING**

**$13.7**

**$15.6**

**$17.8**

**$20.5**

**$23.3**

**$27.1**

**$28.0**

**$28.6**

**$28.6**

**$28.6**

**$0**

**$5**

**$10**

**$15**

**$20**

**$25**

**$30**

**FY**

**1998**

**FY**

**1999**

**FY**

**2000**

**FY**

**2001**

**FY**

**2002**

**FY**

**2003**

**FY**

**2004**

**FY**

**2005**

**FY**

**2006**

**FY**

**2007**

**?**

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

- NIH managed well despite small increases in 2004 (2.9%) and 2005 (2%) by shifting “one time” funds from 2003 to 2004
- 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 Funding Cut-off Line

- 0

- 10

- 20

- 30

- 40

- 100

- 0

- -

- Percentile Score

- Percent R01s Funded

## Success Rate per Application Understates Funding Rate per Applicant

- 0%

- 5%

- 10%

- 15%

- 20%

- 25%

- 30%

- 35%

- 40%

- 1995

- 1997

- 1999

- 2001

- 2003

- 2005

- Applicant

- Applications

- Success Rate for R01 Equivalents

- Fiscal Year

- 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

- Success Rate _per Application_ Understates Funding Rate _per Applicant_

**Notes:**
FY 2005- 22.3% success rate for applications, but 27.6% for applicants
FY 2006- 19.8% for applications, but ~25% for applicants

## 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

## Biomedical Research Has Delivered 

**Biomedical Research ****Has Delivered**** **

*Coronary Heart Disease*

**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

**Biomedical Research ****Has Delivered**

*Cancer*

**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: 

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

- Preemptive

- Personalized

- Predictive

## NIH

**NIH**

*Transforming medicine through discovery*