The drive to double spending by the National Institutes of Health between 1998 and 2003 reached its halfway point Dec. 15, when Congress approved a new NIH budget that represented a 50 percent increase from just three years ago. A 14 percent boost of $2.5 billion propels NIH spending to $20.3 billion for fiscal year 2001. The support expressed by President-elect George W. Bush during the presidential campaign to double NIH spending signals that the agency remains on track to double its budget in just five years. The increase for 2001 far exceeds the Clinton administration's requested 5.6 percent addition of $1 billion and marks the third 14 percent hike in a row. Acting NIH director Ruth Kirschstein had called the first two increases in 1998 and 1999 "unprecedented" and the increase proves again the bipartisan popularity in Congress for medical research.
Generosity, however, doesn't mean timeliness as Congress once again failed to pass the NIH budget by the October start of the federal fiscal year because it could not agree on provisions in a larger bill of which NIH funding was part. Congress fell back on "Continuing Resolutions" to finance NIH at last year's level while Republicans and Democrats wrangled over the $108.9 billion Labor, Health and Human Services, and Education appropriations bill. The skirmishes ranged from legalizing illegal immigrants to assisting high-speed passenger rail, to saving endangered Steller sea lions, to the federal role in education. When the logrolling and horse-trading finally came to a stop, NIH not only wound up with another whopping increase, but found its budget free of the earmarking commonplace for most federal agencies.
Initiatives: Minorities, Genomics, Clinical Trials, and Training
The budget includes $130 million to start a new granting agency within NIH, the National Center for Research on Minority Health and Health Disparities. Replacing the old Office of Research on Minority Health, the center funds or co-funds grants and contracts aimed at understanding and eliminating health disparities among minorities, including African Americans, Hispanics, Native Americans, Asian Americans, Pacific Islanders, and Caucasians identified as medically underserved. Health disparities refer to differences in the burden of diseases affecting minorities, including mortality, incidence, and prevalence.
John Ruffin, the center's director, wants to target some of the important biologically based disparities for basic research. Why, he asks, do racial differences exist in responses to interferon treatments for chronic Hepatitis C; or why do Native Americans suffer higher than usual incidence of meningitis; or why do African Americans disproportionately suffer from autoimmune disease? Minorities will benefit more from clinical research if the center can encourage them to greater participation in clinical trials. The center will also support training of minority scientists and facilities improvements related to their needs.
In 2001, NIH will expand research opportunities for clinical investigators through greater funding of programs begun in 1999. Newcomers to clinical research--third- and fourth-year medical students in particular--will benefit from Mentored Patient-Oriented Research Career Awards; established investigators will be able to apply for Mid-Career Investigator Awards in Patient-Oriented Research. This year should also see the launch of an extramural education-loan repayment program for clinical investigators with disadvantaged backgrounds.
The National Human Genome Research Institute (NHGRI) will use part of its budget increase to establish new academic Centers of Excellence in Genomic Science, says Kathy Hudson, NHGRI assistant director. CEGS grants support multi-investigator teams developing interdisciplinary approaches that apply genomics to biological problems. NHGRI particularly wants to fund teams that combine experiment with bioinformatics. The CEGS will also train new scientists, both biological and nonbiological, for careers in genomics, to help meet the intense demand for the interdisciplinary skills required to explore the genome.
At the National Cancer Institute, a new grant program called "Quick Trials" will expand following its development and startup in 2000. Quick Trials streamlines grant application procedures so that Phase I and II cancer therapy trials are funded several months sooner than happens with RO1 grants.
The arrival of the new government administration appears unlikely to sidetrack NIH's budget momentum. While President-elect Bush is on record for supporting the goal of doubling NIH funding, his support does not extend to research using human pluripotent stem cells. Federal law lets NIH fund research using human stem cells, but it forbids federal funding of the actual derivation of the cells from human embryos. Bush has promised to uphold a ban on federal research using human stem cells derived from embryos. By presidential executive order, he can overturn the human stem cell research guidelines NIH issued last August. Whether Bush will support work with stem cells harvested from adult cadaver tissues using new techniques is unclear.
Grant Trends: What's Up, What's Not
With Congress stuffing NIH's pockets, are investigator-initiated grants easier to get? It depends on how you look at it. More scientists have gotten money; the number of research project grants (RPGs) has gone up, as has the size of the average grant. Yet despite the big run-up in NIH spending since 1998, the success rate for applications has barely budged.
NIH increases grant funding cautiously, lest spending commitments exceed anticipated budget growth. Last spring, with President Bill Clinton's requested 5.6 percent budget increase in mind, NIH said it would restrain growth of award sizes to a rate below the inflation indicator known as the Biomedical Research and Development Price Index, currently at 3.6 percent. It's unclear how closely this will be followed in 2001, given what Congress bestowed.
In leaner years, according to a senior official in the NIH director's office, NIH tried to hold down the average grant cost. But with the first two 14 percent increases, NIH decided to allow some catch-up, and grant increases of 10 or 11 percent became common. The average competing RPG, including both new and renewal awards, will rise from $295,000 in 1999 to a projected $327,000 in 2001; an 11 percent boost that matches the three-year increase in the biomedical inflation index. The rise could well be greater as this projection comes from President Clinton's less generous budget. Because of Congress' delay in passing a budget and the changeover to the Bush administration, official projections reflecting the 14 percent budget increase are not expected until March or April.
The total number of continuing and competing RPGs will conservatively increase by 10 percent, from 28,700 in 1999 to 31,500 in 2001. Together, more and bigger grants project the total RPG spending to rise 22 percent or more over this period to at least $10.7 billion in 2001. The same years should see intramural research up at least 16 percent, to $1.8 billion or higher.
The application success rate depends on how many grant applications are received, their total cost, and the total amount awarded. Allocations are dependent on how institutes use their money: choosing to apply it to grants as opposed to administration, intramural programs, research center support, training, or other obligations. Success rates have not been estimated for 2001, but in 2000 they were as high as 42 percent at the National Eye Institute and as low as 15 percent at the National Center of Research Resources. The overall success rate in 2000 was 31 percent, up just 3 percent from what it was in 1996, and more or less where it has been for 10 years.
Officially, a success rate of 30 percent is not a problem; it is policy. And while 30 percent is a rate that many researchers say is lousy, it seems a good target for success according to administrators, who like to remind researchers that they (the researchers) also benefit from other NIH expenditures, such as centers and contracts.
The rising number of grants has little to do with success rates and more to do with the overall increase in available funds that encourage more people to fight for a slice of NIH's increasing budget. If success rates remain in the 30 percent range and new grant seekers continue to join the party, a crystal ball isn't required to predict that, even when the NIH budget doubles, obtaining funding could be just as nerve-wracking as it has always been. And if that sounds depressingly like "The more things change, the more they stay the same," remember the sunnier view of the situation: At least the Sisyphean labor of finding the money to keep grad students and postdocs plugging away won't get any worse.
Tom Hollon (email@example.com) is a freelance science writer in Rockville, Md.