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Growth of digestive diseases research funds and investigators supported by the National Institutes of Health
GASTROENTEROLOGY
SPECIAL
REPORTS
AND
1989;97:482-7
REVIEWS
Growth of Digestive Diseases Research Funds and Investigators Supported by the National Institutes of Health SARAH C. KALSER and VAY LIANG W. GO National Bethesda,
Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Maryland: and Department of Medicine, University of California at Los Angeles
School of Medicine,
Los Angeles, California
The object of this paper is to analyze the growth of the digestive diseases research community supported by the National Institutes of Health, based primarily on data from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), during the lo-yr period of fiscal year 1977 through 1988. During that period, research dollars have increased threefold (1.5fold when corrected for inflation), whereas the number of grants supported by those dollars has increased only l&fold. This increase is similar to that of the entire National Institutes of Health. A greater percentage of grantees now have multiple grants and the cost of multiple grants is greater on a per grant basis. One-half of the funds support the research of only one-fourth of the grantees. The number of competing applications sent to the National Institute of Diabetes and Digestive and Kidney Diseases compared with those sent to the National Institutes of Health shows a smaller increase (28% vs. 40%), whereas more funds are being provided per grant. Ten of the 12 institutes within the National Institutes of Health are now reporting digestive disease research support, so that total support exceeded $200 million in fiscal year 1986. We conclude that the digestive diseases research community is growing very slowly.
ederal support for digestive diseases research is heavily concentrated within the National Institutes of Health (NIH), although certain significant activities are also supported by the Alcohol, Drug Abuse, and Mental Health Administration, the Veterans Administration, and the Department of Agriculture. Within the NIH, 10 of 12 institutes and bureaus support some digestive diseases research, but the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is the leading insti-
F
tute, as is evident by the inclusion of “Digestive” in its name. Within the Digestive Diseases and Nutrition Division of the NIDDK, research in digestive diseases is supported under the general areas of gastrointestinal digestion and absorption, gastrointestinal neuroendocrinology, gastrointestinal motility, gastrointestinal mucosa and immunology, gastrointestinal acquired immune deficiency syndrome, pancreas, and liver and biliary diseases. The object of this paper is to analyze the dollar amount support and the number of investigators in digestive diseases research from data of the digestive diseases program of the NIDDK and the NIH. These data show that in the past 10 yr, the budgets of the NIH, NIDDK, and the digestive diseases program within the NIDDK have greatly increased. Unfortunately, the increased budget has not increased the number of researchers; i.e., the cost of the research has increased but the number of researchers has not.
Methods Data for Tables 1 and 2 and Figure 1 come from tables published in NIH data books, Moyer reports prepared for Congressional committees, Digestive Diseases Interagency Coordinating Committee reports, or fiscal charts maintained by the NIDDK, as indicated. The data relevant to the pool size of NIDDK investigators (Table 3) were obtained from special reports generated by the Scientific Programs Information Branch of the NIDDK from records kept on the IMPAC System of the NIH. All NIDDK grantees in digestive diseases programs who were funded
Abbreviations used in this paper: NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases: NIH, National Institutes of Health. 0 1989 by the American Gastroenterological Association 0916~5085/89/$3.50
August 1989
Table
GROWTH
1. Digestive
Diseases-Related 1977 27,799
NIDDK NC1 NIAID DRR NHLBI NICHD NIEHS NIGMS NIDR NINCDS NIA FIC
Grants Funded
by the National
38,286 b
21,040
25,920 3,748 4,707 1,580 2,540 885 920 98
2,375 765 -
OD 51,979 51,979
Total Adjusted”
78,684 67,692
DISEASES
RESEARCH
453
of Health”
1981
1983
1985
1986
45,833 26,870 14,103 8,045 3,541 1,436 2,172 637 1,994 773 -
53,550 32,961 20,513 7,554 4,534 943 1,352 609 2,266 632 -
75,415 60,369 31,142 12,026 8,554 4,614 1,731 2,692 1,952 1,487 1,040 b
79,249 61,496 29,380 11,676 9,972 4,699 3,863 2,233 1,855 1,210 991 210 61
105,404 74,320
124,914 75,885
201,022 108.471
1979
b
Institutes
OF DIGESTIVE
-
206,895 106.799
DRR, Research Resources; FIC, Fogarty International Center; NCI, National Cancer Institute; NHLBI, National Heart, Lung and Blood Institute; NIA, National Institute on Aging; NIAID, National Institute of Allergy and Infectious Diseases; NICHHD, National Institute of Child Health and Human Development; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIDR, National Institute of Dental Research; NIEHS, National Institute of Environmental Health Sciences: NIGMS, National Institute of General Medical Sciences; NINCDS, National Institute of Neurological and Communicative Disorders and Stroke; OD, Office of the Director, National Institutes of Health. Data from Division of Financial Management, Office of the Director, NIH; compiled by the Digestive Diseases using the NIH Biomedical Research and Coordinating Committee. a Amount of dollars in thousands. b No data available. ’ Adjusted Development Price Index.
by it and other institutes of the NIH and whose grant was active during any of the three time periods examined (October 1,1976 to September 30, 1977; October 1,1981 to September 30, 1982; October 1, 1986 to September 30,
Table
1987) were listed in alphabetical order. Program projects and center grants were included for all analyses (except where comparisons with and without large grants were being analyzed in Table 3). Not all grants active during
2. Budgets of the National Institutes of Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Digestive Diseases Program of the National Institute of Diabetes and Digestive and Kidney Diseasesa NIH
Fiscal
No. of grants
Totalb
1436 1638 1952 2161 2331 2408 2702 3087 3591 3739
15,564 16,772 19,204 20,061 20,418 19,893 20,819 21,535 22,958 23,445
220 260 303 341 369 368 413 462 543 548 283
158 187 223 252 281 279 319 363 425 436 225
1936 2333 2639 2778 2839 2708 2812 2829 3019 2975
1986d
2544 2843 3190 3429 3569 3642 4024 4476 5145 5494 2836 116 11
160 34
51
149 29
176 42
54
1978 1979 1980
1981 1982 1983
1984 1985
1986 Adjusted
No. of grants
year
1977
Change FY77-86 Adjusted (%)d
(%)
Research”
Digestive
diseases programs the NIDDK
Total
Research
NIDDK
Total
Research
27.8 33.1 36.8 42.1 45.8 47.3 53.6 63.0 75.4 79.2 40.9 185 47
19.8 23.0 27.9 30.6 35.1 35.8 41.4 50.3 60.7 64.1 33.1 224 67
of
No. of grants 260 263 318 309 333 316 358 359 392 390
50
NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIH, National Institutes of Health. Total represents the entire allocation for grants, contracts, training, intramural research, and management. Research, numbers represent research grant cost and numbers of grants, respectively, and exclude all other items. Data for the NIH and the NIDDK are from the NIH Data Book 1986, Tables 11 and 12; also the NIH Data Books 1978-1985 and recent data from Program Analysis, NIH. Digestive diseases data are from division records. a Dollar amount in millions. b Entire allocation for grants, contracts, training, intramural research, and management. c Research for inflation using the NIH Biomedical Research and Development Price Index. grant cost, excluding all other items. d Adjusted
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Vol. 97, No. 2
% Funded
t
I
I
I
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I
I
F&7879008’8283848!5&3 Fiil Figure
1 Number of competing Digestive and Kidney applications indicated fiscal year.
3.
I
applications submitted to the Digestive Diseases Program of the National Institute of Diabetes and Diseases during the lo-yr span of fiscal years 1977 through 1986. Number of total and amended on left ordinate. Right ordinate shows percentage of approved applications that were funded in each
represent the funds being managed by an individual during any of the three time periods selected and will not strictly correspond with fiscal year data. Fellowship, training grants, and career awards were not included because
Costs of AJI National Institutes of Health Grants Managed Grants (Program Projects, Core Centers)
by Investigators
Including Average
Total
No. per PI FY 1977 1 >l Total FY 1982 1 >l Total FY 1987 1 >l Total
Includes large grants
I
bar
each designated time period will necessarily be paid from the same fiscal year appropriation as there are circumstances in which a grant period is extended and the funding is from a previous fiscal year. Therefore, the data
Table
1
cost in thousands
Excludes large grants
Large grants
Includes large grants
or Excluding
Large
cost in thousands’ (No. of PIs) Excludes large grants
Large grants
14,033 13,229 27,262
12,757 9,800 22,557
1,276 3,429 4,705
66 (213) 210 (63) 99 (276)
61(209) 175 (56) 85 (265)
319 (4) 490 (7) 428 (11)
24,910 18,779 43.689
23,845 15,665 39,510
1,065 3,114 4.179
96(260) 272 (69) 133 (329)
92 (258) 241(65) 122 (323)
532 (2) 779 (4) 696 (6)
40,514 44,047 84,561
36,050 28,317 64,367
4,464 15,730 20,194
153 (264) 479 (92) 237 (356)
139 (259)
416 (68) 197 (327)
893 (5) 655(24) 696 (29)
FY, fiscal year; PI, principal investigator. The signal investigator must be the holder of at least one National Institute of Diabetes and Digestive and Kidney Diseases grant; other grants may be from other National Institutes of Health institutes. The data do not represent fiscal year expenditures but represent the active grants managed from National Institutes of Health funds during the periods examined. LINumbers in parentheses are number of principal investigators. The principal investigator is the person responsible for the scientific management of the grant held by the institution.
August 1989
these grants are made from funding categories distinct from the primary research grant fund.
Results Composite Funding of Digestive Diseases Research Throughout the National Institutes of Health In 1976, the 94th Congress mandated the creation of the Digestive Diseases Coordinating Committee through Public Law 94-562, Section 440A to coordinate and report on digestive diseases activities of the NIH and other federal agencies. Table 1 shows the support of digestive diseases by 10 of 12 NIH institutes as well as three divisions. The NIDDK has continually provided the largest amount of support for digestive diseases. It has also shown the greatest percent rise in digestive diseases funds (185% change during the lo-yr period). However, taken together, the other institutes provide up to twothirds of the digestive diseases research support seen for 1986. The National Cancer Institute and the National Institute of Allergy and Infectious Diseases together provided 90 million dollars support in 1986, a combined total that is greater than the support provided through the NIDDK. The Cancer Institute has major programs in colon, gastric, pancreatic, and liver cancer. The Allergy and Infectious Diseases Institute supports the majority of the work on hepatitis, basic transplant immunology, and enteric illness caused by infectious agents or allergic reactions. The Division of Research Resources, contributing mainly through its support of Clinical Research Centers and the Heart, Lung and Blood Institute, with its research into hepatitis, are next in order of the six major contributors to the program. Table 1 also shows an increasing number of institutes and divisions within the NIH that are now providing significant support for digestive diseases research and the sizeable increase in total support that the NIH is providing to the digestive diseases community. However, part of the increase is artificial due to the more complete reporting now being obtained from all institutes. For example, the National Cancer Institute supported digestive diseases research before 1981, but figures are not available. Support for digestive diseases research from all NIH sources has doubled from 1977 to 1981 and doubled again in 1986, uncorrected for inflation. Even corrected for inflation, support has doubled in 10 yr. In addition, more than 200 million dollars goes to support nutrition research, some of which is digestive diseasesrelated but is not included in this table.
GROWTH OF DIGESTIVE DISEASES RESEARCH
485
Increase in Digestive Diseases Funds in Relation to the Increase in Funds to the National Institute of Diabetes and Digestive and Kidney Diseases and to the National Institutes of Health Table 2 shows that the budget for the Digestive Diseases Program of the NIDDK, both total and for research grants alone, has increased slightly faster in the IO-yr period examined than the respective budgets of either the NIDDK or the NIH. However, the increase in the number of grants supported by all three units is similar. Adjustment for inflation using the NIH Biomedical Research and Development Price Index shows that the lo-yr increase in research budgets is 34%, 42%, and 67% for the NIH, NIDDK, and Digestive Diseases in NIDDK, respectively. It is also evident that each of these components is devoting more of its total funds to research grants: in 1977, only 56%, 72%, and 71% of the entire budget went to research grants compared with 68%, 80%, and 81% in 1986 for the NIH, NIDDK, and Digestive Diseases in NIDDK, respectively. Increase in the Number of Applications to the National Institutes of Health and to the Digestive Diseases Program of the National Institute of Diabetes and Digestive and Kidney Diseases Competing applications to the NIH increased from 13,304 in 1977 to 18,675 in 1985 (40%) (1). However, applications from the digestive diseases community to the NIDDK increased only marginally (Figure l), from 260 to 328 (26%).Most of this small increase can be attributed to investigators resubmitting the same basic project as an amended application. One can see in Figure 1 that these amended applications amount to almost 25% of the applications submitted, the same as the overall increase in digestive diseases applications. Applications place a demand on the system, and the demand translates into increased emphasis in that area. Within the institute, the number of competing applications paid in fiscal year 1985 was 980, 115 of which went to digestive diseases awards. Total awards, including both competing and noncompeting commitments, numbered 392. Therefore, the demand placed on the system by digestive diseases grantees has not increased relative to the institute or the NIH or the dollar increase. Figure 1 also shows the funding picture for digestive diseases research grants as the percentage of approved grants that were funded. The percentage funded slowly declined from -43% in 1977 to 37% in 1986. The increase in number of applications
486
GASTROENTEROLOGY Vol. 97,
KALSERANDGO
seems to show some reciprocity with the percentage awarded; i.e., greater competition for the smaller percentage to be funded. Size of Grants Managed Diseases Investigators
by Digestive
The number of active grants in the program overestimates the number of actual principal investigators because some investigators hold more than one grant at any period of time. To examine this question, we sorted, by name, all digestive diseases investigators with at least one grant funded by the NIDDK. We then examined the number and dollar amounts of grants managed by this named principal investigator from all NIH sources. This was analyzed for three periods in time: grants active in fiscal years 1977, 1982, and 1987. Table 3 shows the number of grants and dollar cost managed by principal investigators having one or more grants from the NIH, one of which was from the NIDDK. The data are further divided to include or exclude large grants [Program Projects, Core Centers). The data show that the total cost of all grants is about equally divided between those investigators with one compared with more than one grant in each of the three periods analyzed. For example, in 1977, investigators with multiple grants controlled $13,229 compared with $14,033 for single grant holders (49% of funds). By 1987, multiple grant holders had 52% of funds. However, when one looks at the numbers of principal investigators, in 1977, 23% of investigators had multiple grants and had 49% of the funds. In 1987, 26% of investigators had 52% of funds. The percentage of NIDDK grantees holding multiple grants was less than the NIH cohort, but they showed a steady increase. In 1977, 11.2%; in 1982, 12.8%; and in 1987, 15.2% of digestive diseases grantees had multiple grants within the NIDDK. In 1987, 26 of the 54 investigators managing multiple grants held a Program Project or Core Center grant compared with 7 and 6 in 1977 and 1982, respectively. They were thus managing not only their own research but that of a larger research team supported by the large grant. Table 3 also shows that the average cost of a grant increased disproportionately as the number of grants increased. That is, in 1977 the holder of one grant managed an average of $66,000 annually, whereas the holder of two or more grants managed an average of $210,000 per year, even though 90% of the investigators held only two grants and we would anticipate a cost of $132,000 for their holdings. By 1987, the average cost of the multiple grant holding was $479,000, compared with $153,000 for the grantee
No.
2
with a single grant, more than three times as much. The larger cost per grant as the number of grants increases might reflect the increasing number and cost of the large grant mechanisms, i.e., the Program Project and the Core Center. Therefore, data in Table 3 also compare costs including and excluding the contributions from the large grants, in order to determine whether the increased cost seen for the multiple grants is due primarily to the large grant mechanisms. Costs calculated with or without inclusion of the large grants are very close; $99,000 versus $85,000 in 1977 for average cost with and without large grants, respectively. Even in 1987, when the average cost of a grant had doubled, the cost calculated with or without large grants is very close, $237,000 versus $197,000, respectively. This is due to the small number of large grant holders and the fact that the average cost of the large grant has not increased as rapidly. In summary, NIDDK has shown only a modest increase in the number of grantees it supports in digestive diseases during a lo-yr period. A greater percentage of those grantees have multiple grants from the NIDDK, the cost of multiple grants is greater on a per grant basis, and therefore the sizeable increase in dollars to digestive diseases research in the lo-yr period examined has not resulted in an equally large increase in the number of principal investigators holding research grants. Discussion Many investigators in digestive diseases now hold multiple grants and the dollar amount of these grants is increasing faster than that of the single grant holder. It is quite possible that the holding of multiple grants is a more general trend, perhaps reflecting apprehension by investigators about “putting all their eggs in one basket” when the competition for funding has increased, i.e., the award rate of approved grants has dropped from about 43% to 37% in the NIDDK over this lo-yr span. This disproportionate increase in cost possibly reflects, the more senior status and larger group of collaborators involved, irrespective of grant mechanism, as an investigator is able to do research in more than one area. A small part of the increase is attributable to the increase in indirect cost that occurred during the lo-yr span (27% of total cost versus 31%). This is a limited analysis, yet coupled with a very comprehensive survey on reasons why young investigators trained in digestive diseases are not staying in the discipline (2), it presents some concern for the future. The NIH is trying to address this generic problem by providing special award programs for young investigators (FIRST award) and for those
August
GROWTH
1989
needing additional research training (Physician Scientist Award; Clinical Investigator Award]. In addition, in the digestive diseases field, the American Gastroenterological Association has made major efforts to provide supplemental fellowship awards. In conjunction with the Health Industry Scholars Program, the American Gastroenterological Association provides five or six young investigators each year with 3 yr of partial support. Among the private organizations, the National Foundation for Ileitis and Colitis and the American Liver Foundation provide small amounts for training and research endeavors of young medical scientists. However, the digestive diseases community has no single large organization to provide the scale of support that is provided, for example, by the American Cancer Society or the American Heart Association, which spent about 63 and 53 million dollars, respectively, on research in 1985 (Pew Report). In summary, in spite of a generous increase in funds going into digestive diseases research within the NIDDK and the NIH, the health of this discipline is threatened by a lack of growth in the number of investigators submitting research applications. It is especially notable that about one-fourth of these investigators are holding multiple grants and that the actual pool of investigators supported by the NIDDK has grown only modestly between 1977 and 1986. We would recommend the following actions, which may bring more investigators into the digestive diseases research field. Encourage all of the NIH institutes to participate and increase their efforts in digestive diseases research by receiving projects that are highly relevant to their categorical interests and expand their budgetary support according to their respective mission and goals as outlined in a publication from the Digestive Diseases Interagency Coordinating Committee (3). Encourage more coinvestigators to develop and submit independent projects, thereby holding
3
4
5
6
OF DIGESTIVE
DISEASES
RESEARCH
487
down costs because new projects normally require less support. Make research training experiences in digestive diseases exciting and relevant so that more young investigators will be attracted into the field and be retained. Training for digestive diseases research should be encouraged in other NIH institutes in addition to the research training programs supported by the NIDDK. This could provide multidisciplinary and basic science approaches currently so important to most clinical areas. Encourage private foundations and organizations to increase their support of “bridging” funds for young investigators. These funds support preliminary studies that need to be performed before major research application submissions to provide greater credibility for the proposed work. Digestive diseases researchers should encourage basic scientists from many disciplines to enter the digestive diseases field by developing collaborations.
References NIH data book 1986. (NIH Publication No. 87-1261; December 1986.) Trier JS. The future of digestive diseases research: is there cause for concern? Gastroenterology 1986;91:797-801. Digestive Diseases Research at the National Institutes of Health. Administrative Document, May 1988. (Available from the National Digestive Diseases Interagency Committee, P.O. Box NDDIC, Bethesda, Maryland 20892.)
Received June 30, 1988. Accepted March 6, 1989. Address requests for reprints to: Sarah C. Kalser, Ph.D., National Institute of Diabetes and Digestive and Kidney Diseases/ National Institutes of Health, Westwood Building, Room 3A-17, Bethesda, Maryland 20892. The authors thank Clementine Whitaker and Harvey Balderson for developing the program to obtain National Institutes of Health grantee data, Rosalind Gray of the Office of the Director, National Institutes of Health, for fiscal data, and Mary Adkins for secretarial assistance.
SPECIAL
REPORTS
AND
1989;97:482-7
REVIEWS
Growth of Digestive Diseases Research Funds and Investigators Supported by the National Institutes of Health SARAH C. KALSER and VAY LIANG W. GO National Bethesda,
Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Maryland: and Department of Medicine, University of California at Los Angeles
School of Medicine,
Los Angeles, California
The object of this paper is to analyze the growth of the digestive diseases research community supported by the National Institutes of Health, based primarily on data from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), during the lo-yr period of fiscal year 1977 through 1988. During that period, research dollars have increased threefold (1.5fold when corrected for inflation), whereas the number of grants supported by those dollars has increased only l&fold. This increase is similar to that of the entire National Institutes of Health. A greater percentage of grantees now have multiple grants and the cost of multiple grants is greater on a per grant basis. One-half of the funds support the research of only one-fourth of the grantees. The number of competing applications sent to the National Institute of Diabetes and Digestive and Kidney Diseases compared with those sent to the National Institutes of Health shows a smaller increase (28% vs. 40%), whereas more funds are being provided per grant. Ten of the 12 institutes within the National Institutes of Health are now reporting digestive disease research support, so that total support exceeded $200 million in fiscal year 1986. We conclude that the digestive diseases research community is growing very slowly.
ederal support for digestive diseases research is heavily concentrated within the National Institutes of Health (NIH), although certain significant activities are also supported by the Alcohol, Drug Abuse, and Mental Health Administration, the Veterans Administration, and the Department of Agriculture. Within the NIH, 10 of 12 institutes and bureaus support some digestive diseases research, but the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is the leading insti-
F
tute, as is evident by the inclusion of “Digestive” in its name. Within the Digestive Diseases and Nutrition Division of the NIDDK, research in digestive diseases is supported under the general areas of gastrointestinal digestion and absorption, gastrointestinal neuroendocrinology, gastrointestinal motility, gastrointestinal mucosa and immunology, gastrointestinal acquired immune deficiency syndrome, pancreas, and liver and biliary diseases. The object of this paper is to analyze the dollar amount support and the number of investigators in digestive diseases research from data of the digestive diseases program of the NIDDK and the NIH. These data show that in the past 10 yr, the budgets of the NIH, NIDDK, and the digestive diseases program within the NIDDK have greatly increased. Unfortunately, the increased budget has not increased the number of researchers; i.e., the cost of the research has increased but the number of researchers has not.
Methods Data for Tables 1 and 2 and Figure 1 come from tables published in NIH data books, Moyer reports prepared for Congressional committees, Digestive Diseases Interagency Coordinating Committee reports, or fiscal charts maintained by the NIDDK, as indicated. The data relevant to the pool size of NIDDK investigators (Table 3) were obtained from special reports generated by the Scientific Programs Information Branch of the NIDDK from records kept on the IMPAC System of the NIH. All NIDDK grantees in digestive diseases programs who were funded
Abbreviations used in this paper: NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases: NIH, National Institutes of Health. 0 1989 by the American Gastroenterological Association 0916~5085/89/$3.50
August 1989
Table
GROWTH
1. Digestive
Diseases-Related 1977 27,799
NIDDK NC1 NIAID DRR NHLBI NICHD NIEHS NIGMS NIDR NINCDS NIA FIC
Grants Funded
by the National
38,286 b
21,040
25,920 3,748 4,707 1,580 2,540 885 920 98
2,375 765 -
OD 51,979 51,979
Total Adjusted”
78,684 67,692
DISEASES
RESEARCH
453
of Health”
1981
1983
1985
1986
45,833 26,870 14,103 8,045 3,541 1,436 2,172 637 1,994 773 -
53,550 32,961 20,513 7,554 4,534 943 1,352 609 2,266 632 -
75,415 60,369 31,142 12,026 8,554 4,614 1,731 2,692 1,952 1,487 1,040 b
79,249 61,496 29,380 11,676 9,972 4,699 3,863 2,233 1,855 1,210 991 210 61
105,404 74,320
124,914 75,885
201,022 108.471
1979
b
Institutes
OF DIGESTIVE
-
206,895 106.799
DRR, Research Resources; FIC, Fogarty International Center; NCI, National Cancer Institute; NHLBI, National Heart, Lung and Blood Institute; NIA, National Institute on Aging; NIAID, National Institute of Allergy and Infectious Diseases; NICHHD, National Institute of Child Health and Human Development; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIDR, National Institute of Dental Research; NIEHS, National Institute of Environmental Health Sciences: NIGMS, National Institute of General Medical Sciences; NINCDS, National Institute of Neurological and Communicative Disorders and Stroke; OD, Office of the Director, National Institutes of Health. Data from Division of Financial Management, Office of the Director, NIH; compiled by the Digestive Diseases using the NIH Biomedical Research and Coordinating Committee. a Amount of dollars in thousands. b No data available. ’ Adjusted Development Price Index.
by it and other institutes of the NIH and whose grant was active during any of the three time periods examined (October 1,1976 to September 30, 1977; October 1,1981 to September 30, 1982; October 1, 1986 to September 30,
Table
1987) were listed in alphabetical order. Program projects and center grants were included for all analyses (except where comparisons with and without large grants were being analyzed in Table 3). Not all grants active during
2. Budgets of the National Institutes of Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Digestive Diseases Program of the National Institute of Diabetes and Digestive and Kidney Diseasesa NIH
Fiscal
No. of grants
Totalb
1436 1638 1952 2161 2331 2408 2702 3087 3591 3739
15,564 16,772 19,204 20,061 20,418 19,893 20,819 21,535 22,958 23,445
220 260 303 341 369 368 413 462 543 548 283
158 187 223 252 281 279 319 363 425 436 225
1936 2333 2639 2778 2839 2708 2812 2829 3019 2975
1986d
2544 2843 3190 3429 3569 3642 4024 4476 5145 5494 2836 116 11
160 34
51
149 29
176 42
54
1978 1979 1980
1981 1982 1983
1984 1985
1986 Adjusted
No. of grants
year
1977
Change FY77-86 Adjusted (%)d
(%)
Research”
Digestive
diseases programs the NIDDK
Total
Research
NIDDK
Total
Research
27.8 33.1 36.8 42.1 45.8 47.3 53.6 63.0 75.4 79.2 40.9 185 47
19.8 23.0 27.9 30.6 35.1 35.8 41.4 50.3 60.7 64.1 33.1 224 67
of
No. of grants 260 263 318 309 333 316 358 359 392 390
50
NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIH, National Institutes of Health. Total represents the entire allocation for grants, contracts, training, intramural research, and management. Research, numbers represent research grant cost and numbers of grants, respectively, and exclude all other items. Data for the NIH and the NIDDK are from the NIH Data Book 1986, Tables 11 and 12; also the NIH Data Books 1978-1985 and recent data from Program Analysis, NIH. Digestive diseases data are from division records. a Dollar amount in millions. b Entire allocation for grants, contracts, training, intramural research, and management. c Research for inflation using the NIH Biomedical Research and Development Price Index. grant cost, excluding all other items. d Adjusted
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F&7879008’8283848!5&3 Fiil Figure
1 Number of competing Digestive and Kidney applications indicated fiscal year.
3.
I
applications submitted to the Digestive Diseases Program of the National Institute of Diabetes and Diseases during the lo-yr span of fiscal years 1977 through 1986. Number of total and amended on left ordinate. Right ordinate shows percentage of approved applications that were funded in each
represent the funds being managed by an individual during any of the three time periods selected and will not strictly correspond with fiscal year data. Fellowship, training grants, and career awards were not included because
Costs of AJI National Institutes of Health Grants Managed Grants (Program Projects, Core Centers)
by Investigators
Including Average
Total
No. per PI FY 1977 1 >l Total FY 1982 1 >l Total FY 1987 1 >l Total
Includes large grants
I
bar
each designated time period will necessarily be paid from the same fiscal year appropriation as there are circumstances in which a grant period is extended and the funding is from a previous fiscal year. Therefore, the data
Table
1
cost in thousands
Excludes large grants
Large grants
Includes large grants
or Excluding
Large
cost in thousands’ (No. of PIs) Excludes large grants
Large grants
14,033 13,229 27,262
12,757 9,800 22,557
1,276 3,429 4,705
66 (213) 210 (63) 99 (276)
61(209) 175 (56) 85 (265)
319 (4) 490 (7) 428 (11)
24,910 18,779 43.689
23,845 15,665 39,510
1,065 3,114 4.179
96(260) 272 (69) 133 (329)
92 (258) 241(65) 122 (323)
532 (2) 779 (4) 696 (6)
40,514 44,047 84,561
36,050 28,317 64,367
4,464 15,730 20,194
153 (264) 479 (92) 237 (356)
139 (259)
416 (68) 197 (327)
893 (5) 655(24) 696 (29)
FY, fiscal year; PI, principal investigator. The signal investigator must be the holder of at least one National Institute of Diabetes and Digestive and Kidney Diseases grant; other grants may be from other National Institutes of Health institutes. The data do not represent fiscal year expenditures but represent the active grants managed from National Institutes of Health funds during the periods examined. LINumbers in parentheses are number of principal investigators. The principal investigator is the person responsible for the scientific management of the grant held by the institution.
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these grants are made from funding categories distinct from the primary research grant fund.
Results Composite Funding of Digestive Diseases Research Throughout the National Institutes of Health In 1976, the 94th Congress mandated the creation of the Digestive Diseases Coordinating Committee through Public Law 94-562, Section 440A to coordinate and report on digestive diseases activities of the NIH and other federal agencies. Table 1 shows the support of digestive diseases by 10 of 12 NIH institutes as well as three divisions. The NIDDK has continually provided the largest amount of support for digestive diseases. It has also shown the greatest percent rise in digestive diseases funds (185% change during the lo-yr period). However, taken together, the other institutes provide up to twothirds of the digestive diseases research support seen for 1986. The National Cancer Institute and the National Institute of Allergy and Infectious Diseases together provided 90 million dollars support in 1986, a combined total that is greater than the support provided through the NIDDK. The Cancer Institute has major programs in colon, gastric, pancreatic, and liver cancer. The Allergy and Infectious Diseases Institute supports the majority of the work on hepatitis, basic transplant immunology, and enteric illness caused by infectious agents or allergic reactions. The Division of Research Resources, contributing mainly through its support of Clinical Research Centers and the Heart, Lung and Blood Institute, with its research into hepatitis, are next in order of the six major contributors to the program. Table 1 also shows an increasing number of institutes and divisions within the NIH that are now providing significant support for digestive diseases research and the sizeable increase in total support that the NIH is providing to the digestive diseases community. However, part of the increase is artificial due to the more complete reporting now being obtained from all institutes. For example, the National Cancer Institute supported digestive diseases research before 1981, but figures are not available. Support for digestive diseases research from all NIH sources has doubled from 1977 to 1981 and doubled again in 1986, uncorrected for inflation. Even corrected for inflation, support has doubled in 10 yr. In addition, more than 200 million dollars goes to support nutrition research, some of which is digestive diseasesrelated but is not included in this table.
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Increase in Digestive Diseases Funds in Relation to the Increase in Funds to the National Institute of Diabetes and Digestive and Kidney Diseases and to the National Institutes of Health Table 2 shows that the budget for the Digestive Diseases Program of the NIDDK, both total and for research grants alone, has increased slightly faster in the IO-yr period examined than the respective budgets of either the NIDDK or the NIH. However, the increase in the number of grants supported by all three units is similar. Adjustment for inflation using the NIH Biomedical Research and Development Price Index shows that the lo-yr increase in research budgets is 34%, 42%, and 67% for the NIH, NIDDK, and Digestive Diseases in NIDDK, respectively. It is also evident that each of these components is devoting more of its total funds to research grants: in 1977, only 56%, 72%, and 71% of the entire budget went to research grants compared with 68%, 80%, and 81% in 1986 for the NIH, NIDDK, and Digestive Diseases in NIDDK, respectively. Increase in the Number of Applications to the National Institutes of Health and to the Digestive Diseases Program of the National Institute of Diabetes and Digestive and Kidney Diseases Competing applications to the NIH increased from 13,304 in 1977 to 18,675 in 1985 (40%) (1). However, applications from the digestive diseases community to the NIDDK increased only marginally (Figure l), from 260 to 328 (26%).Most of this small increase can be attributed to investigators resubmitting the same basic project as an amended application. One can see in Figure 1 that these amended applications amount to almost 25% of the applications submitted, the same as the overall increase in digestive diseases applications. Applications place a demand on the system, and the demand translates into increased emphasis in that area. Within the institute, the number of competing applications paid in fiscal year 1985 was 980, 115 of which went to digestive diseases awards. Total awards, including both competing and noncompeting commitments, numbered 392. Therefore, the demand placed on the system by digestive diseases grantees has not increased relative to the institute or the NIH or the dollar increase. Figure 1 also shows the funding picture for digestive diseases research grants as the percentage of approved grants that were funded. The percentage funded slowly declined from -43% in 1977 to 37% in 1986. The increase in number of applications
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seems to show some reciprocity with the percentage awarded; i.e., greater competition for the smaller percentage to be funded. Size of Grants Managed Diseases Investigators
by Digestive
The number of active grants in the program overestimates the number of actual principal investigators because some investigators hold more than one grant at any period of time. To examine this question, we sorted, by name, all digestive diseases investigators with at least one grant funded by the NIDDK. We then examined the number and dollar amounts of grants managed by this named principal investigator from all NIH sources. This was analyzed for three periods in time: grants active in fiscal years 1977, 1982, and 1987. Table 3 shows the number of grants and dollar cost managed by principal investigators having one or more grants from the NIH, one of which was from the NIDDK. The data are further divided to include or exclude large grants [Program Projects, Core Centers). The data show that the total cost of all grants is about equally divided between those investigators with one compared with more than one grant in each of the three periods analyzed. For example, in 1977, investigators with multiple grants controlled $13,229 compared with $14,033 for single grant holders (49% of funds). By 1987, multiple grant holders had 52% of funds. However, when one looks at the numbers of principal investigators, in 1977, 23% of investigators had multiple grants and had 49% of the funds. In 1987, 26% of investigators had 52% of funds. The percentage of NIDDK grantees holding multiple grants was less than the NIH cohort, but they showed a steady increase. In 1977, 11.2%; in 1982, 12.8%; and in 1987, 15.2% of digestive diseases grantees had multiple grants within the NIDDK. In 1987, 26 of the 54 investigators managing multiple grants held a Program Project or Core Center grant compared with 7 and 6 in 1977 and 1982, respectively. They were thus managing not only their own research but that of a larger research team supported by the large grant. Table 3 also shows that the average cost of a grant increased disproportionately as the number of grants increased. That is, in 1977 the holder of one grant managed an average of $66,000 annually, whereas the holder of two or more grants managed an average of $210,000 per year, even though 90% of the investigators held only two grants and we would anticipate a cost of $132,000 for their holdings. By 1987, the average cost of the multiple grant holding was $479,000, compared with $153,000 for the grantee
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with a single grant, more than three times as much. The larger cost per grant as the number of grants increases might reflect the increasing number and cost of the large grant mechanisms, i.e., the Program Project and the Core Center. Therefore, data in Table 3 also compare costs including and excluding the contributions from the large grants, in order to determine whether the increased cost seen for the multiple grants is due primarily to the large grant mechanisms. Costs calculated with or without inclusion of the large grants are very close; $99,000 versus $85,000 in 1977 for average cost with and without large grants, respectively. Even in 1987, when the average cost of a grant had doubled, the cost calculated with or without large grants is very close, $237,000 versus $197,000, respectively. This is due to the small number of large grant holders and the fact that the average cost of the large grant has not increased as rapidly. In summary, NIDDK has shown only a modest increase in the number of grantees it supports in digestive diseases during a lo-yr period. A greater percentage of those grantees have multiple grants from the NIDDK, the cost of multiple grants is greater on a per grant basis, and therefore the sizeable increase in dollars to digestive diseases research in the lo-yr period examined has not resulted in an equally large increase in the number of principal investigators holding research grants. Discussion Many investigators in digestive diseases now hold multiple grants and the dollar amount of these grants is increasing faster than that of the single grant holder. It is quite possible that the holding of multiple grants is a more general trend, perhaps reflecting apprehension by investigators about “putting all their eggs in one basket” when the competition for funding has increased, i.e., the award rate of approved grants has dropped from about 43% to 37% in the NIDDK over this lo-yr span. This disproportionate increase in cost possibly reflects, the more senior status and larger group of collaborators involved, irrespective of grant mechanism, as an investigator is able to do research in more than one area. A small part of the increase is attributable to the increase in indirect cost that occurred during the lo-yr span (27% of total cost versus 31%). This is a limited analysis, yet coupled with a very comprehensive survey on reasons why young investigators trained in digestive diseases are not staying in the discipline (2), it presents some concern for the future. The NIH is trying to address this generic problem by providing special award programs for young investigators (FIRST award) and for those
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needing additional research training (Physician Scientist Award; Clinical Investigator Award]. In addition, in the digestive diseases field, the American Gastroenterological Association has made major efforts to provide supplemental fellowship awards. In conjunction with the Health Industry Scholars Program, the American Gastroenterological Association provides five or six young investigators each year with 3 yr of partial support. Among the private organizations, the National Foundation for Ileitis and Colitis and the American Liver Foundation provide small amounts for training and research endeavors of young medical scientists. However, the digestive diseases community has no single large organization to provide the scale of support that is provided, for example, by the American Cancer Society or the American Heart Association, which spent about 63 and 53 million dollars, respectively, on research in 1985 (Pew Report). In summary, in spite of a generous increase in funds going into digestive diseases research within the NIDDK and the NIH, the health of this discipline is threatened by a lack of growth in the number of investigators submitting research applications. It is especially notable that about one-fourth of these investigators are holding multiple grants and that the actual pool of investigators supported by the NIDDK has grown only modestly between 1977 and 1986. We would recommend the following actions, which may bring more investigators into the digestive diseases research field. Encourage all of the NIH institutes to participate and increase their efforts in digestive diseases research by receiving projects that are highly relevant to their categorical interests and expand their budgetary support according to their respective mission and goals as outlined in a publication from the Digestive Diseases Interagency Coordinating Committee (3). Encourage more coinvestigators to develop and submit independent projects, thereby holding
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down costs because new projects normally require less support. Make research training experiences in digestive diseases exciting and relevant so that more young investigators will be attracted into the field and be retained. Training for digestive diseases research should be encouraged in other NIH institutes in addition to the research training programs supported by the NIDDK. This could provide multidisciplinary and basic science approaches currently so important to most clinical areas. Encourage private foundations and organizations to increase their support of “bridging” funds for young investigators. These funds support preliminary studies that need to be performed before major research application submissions to provide greater credibility for the proposed work. Digestive diseases researchers should encourage basic scientists from many disciplines to enter the digestive diseases field by developing collaborations.
References NIH data book 1986. (NIH Publication No. 87-1261; December 1986.) Trier JS. The future of digestive diseases research: is there cause for concern? Gastroenterology 1986;91:797-801. Digestive Diseases Research at the National Institutes of Health. Administrative Document, May 1988. (Available from the National Digestive Diseases Interagency Committee, P.O. Box NDDIC, Bethesda, Maryland 20892.)
Received June 30, 1988. Accepted March 6, 1989. Address requests for reprints to: Sarah C. Kalser, Ph.D., National Institute of Diabetes and Digestive and Kidney Diseases/ National Institutes of Health, Westwood Building, Room 3A-17, Bethesda, Maryland 20892. The authors thank Clementine Whitaker and Harvey Balderson for developing the program to obtain National Institutes of Health grantee data, Rosalind Gray of the Office of the Director, National Institutes of Health, for fiscal data, and Mary Adkins for secretarial assistance.