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

2. 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

3. 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%

4. NIH Budget:
Myths and Realities…

5. 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?

6. Basic and Applied Research
60.0%
56.4%
55.2%
55.8%
53.9%
55.2%
55.2%
56.6%
52.1%
56.1%
53.0%
50.0%
43.5%
40.5%
41.0%
41.0%
40.8%
39.2%
39.8%
40.0%
40.8%
38.4%
38.5%
30.0%
20.0%
10.0%
7.0%
5.7%
5.5%
5.2%
4.8%
5.0%
3.7%
3.1%
3.1%
3.6%
0.0%
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

7. 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?

8. 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?

9. NIH Roadmap for Medical Research
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
Non-Roadmap
99.2%
($28,520 Million)
Roadmap
0.8%
($237 Million)

10. 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
BRDPI FY04 (actual) 3.5%
FY05 (est.) %
FY06 (est.) %
FY07 (est.) %

11. New Grant Applications and Success Rates During and After Doubling Period
35%
60,000
49,656
30%
31%
50,000
43,069
25%
+8,359
40,000
Projected
20%
22%
+8,303
Number of Applications
% Success Rate of Grants Funded
19%
30,000
24,154
15%
20,000
10%
10,000 5% 0%
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Success Rates
Applications

12. As Many Applicants in Past 2 Years as During Previous 5 Years!≈
5334
5208
(2003) – (1999)
(2005) – (2003)
Period of doubling

13. The Budget Cycling Phenomenon: What Funds are Available in any One Year?
From current year to
previous year
Budget Increase
Uncommitted Funds
From ending grants
started 4-5 years ago
Continuing grants
Committed Funds
NIH Appropriations

14. NIH Congressional Appropriations
$30
$28.6
$28.0
$28.6
$28.6
$27.1
$25
$23.3 ?
$20
$20.5
$17.8
Billions of Dollars
$15
$15.6
$13.7
$10 $5 $0 FY FY FY FY FY FY FY FY FY FY
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
DOUBLING

15. 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

16. The Question on Everyone’s Mind: What are MY chances of being funded?

17. Payline Is Not Funding Cut-off Line
>99% of grants under the
payline are funded
Payline
100 - 75 -
Success Rate
per application
Percent R01s Funded 50 - 25 - 10 20 30 40
Percentile Score

18. Success Rate per Application Understates Funding Rate per Applicant
40%
Applicant
35%
22.3%
27.6%
30%
25%
Applications
Success Rate for R01 Equivalents
20%
15%
FY % success rate for applications, but 27.6% for applicants
FY % for applications, but ~25% for applicants
10% 5% 0%
1995
1997
1999
2001
2003
2005
Fiscal Year
Success Rate files as of May 3, Program srf_indiv_060103_rfm
Individuals are determined using the pi_profile_person_id in IMPAC-II

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

20. 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

21. Biomedical Research Has Delivered
Coronary Heart Disease
500
400
300
200
100 50 55 60 65 70 75 80 85 90 95 00
Deaths per 100,000
Year
~ 514,000 Actual
Deaths in 2000
~ 1,329,000 Projected
63% decrease in Mortality
~ 1 million early deaths averted per year
$2.6 trillion in economic return
New, effective treatments and prevention strategies
Average investment
per American
~$3.70
per year
30-year investment
per American:
~$110
Total
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

22. Biomedical Research Has Delivered
Cancer
Millions of People
1971
1986
1990
2003 9 6 3
For the first time in recorded history, annual cancer deaths in the United States have fallen
10 million survivors
Advent of early detection and screening
Average investment
per American
~$8.60
per year
30-year investment
per American:
~$260
Total
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

23. Basic Discovery Today Provides the Foundation for Tomorrow’s Medicine
Clinical
Applications
Translational
Research
Basic Research
and
Technology Development

24. Transform Medicine from Curative to Preemptive
The Future Paradigm:
Transform Medicine from Curative to Preemptive
Predictive
Personalized
Preemptive
Participatory

25. Transforming medicine through discovery
NIH