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Broken Pipeline

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Published Jul 1, 2008 8:00 AM


By Dr. Gerald S. Levey, Vice Chancellor, Medical Sciences;
Dean, David Geffen School of Medicine at UCLA

The head of an academic medical center is many things: an administrator, a doctor, a fundraiser, a researcher and a scholar. But for me, one of the most fulfilling roles is that of mentor.

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Photo illustration by Polly Becker

UCLA, with its breadth and depth of talent, is literally brimming with young women and men in our classrooms, labs and clinics working day in and day out to discover new cures, new clinical applications, better ways to prevent illness and to treat our patients. It is pure joy to listen to their enthusiasm and, when possible, to help guide them through the trials and tribulations that confront all of us in academic medicine.

I'm not an overbearing mentor — most of these young doctors and researchers do not need or want that kind of attention. But it is my responsibility to look at the big picture and how decisions made far from Los Angeles will impact the career paths of the next generation of scientists and healers. And no issue is more troubling than the current state of funding for the National Institutes of Health (NIH).

A report issued earlier this year by UCLA and six other academic research institutions warns that five consecutive years of stagnant funding for the NIH, combined with the effects of inflation, have resulted in a 13-percent drop in purchasing power for the agency. According to the report, "A Broken Pipeline? Flat Funding of the NIH Puts a Generation of Science at Risk," if current funding trends continue, America stands to lose a generation of young researchers like Isla Garraway M.D. '99, Ph.D. '99, assistant professor of urology and a member of UCLA's Jonsson Comprehensive Cancer Center, who is working to identify markers on stem cells so they can be used in targeted treatments for prostate cancer. Dr. Garraway and Dr. Michael Rodriguez M.D. '88, UCLA associate professor of family medicine who researches the impact of ethnicity and socioeconomic states on health problems, were among the young researchers profiled in the report.

Even at UCLA, which in the most recent available rankings is 6th in the U.S. in NIH funding, the most promising young faculty struggle to get that first NIH grant. And those who are fortunate enough to get NIH funding, like Dr. Rodriguez, must cope with constant and deep cuts to their grants. As Dr. Rodriguez puts it: "Twenty-four hours a day, seven days a week, you're thinking about your grant proposals and wondering how to survive in a world where fewer people are getting funded and proposals that are funded aren't fully funded or are being cut."

Perhaps the President and Congress don't realize the direct link between funding for the NIH and funding for the research that saves lives. The NIH spends more than 80 percent of its annual budget on public-domain research at academic institutions. The success of expensive, time-intensive, complex research projects like Dr. Garraway's and Dr. Rodriguez's is entirely dependent on the receipt of what the NIH calls an RO1 grant — the major, multiyear grant that is a required credential to launch a career in basic and clinical research. (NIH uses activity codes to differentiate the wide variety of activities it supports, such as conferences, clinical trials, technology transfer and research projects, among others. RO indicates an NIH research grant.)

But due to current funding limitations, the overall success rate for NIH research grants dropped from 32 percent in 1999 to 24 percent in 2007, which means that three of every four are not being funded. Further, most successful grants now require two or three submissions to NIH before being funded. And proposals that do get funded are not fully funded.

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Want to know more about the crisis in NIH funding? Visit www.BrokenPipeline.org for media coverage and Congressional testimony and to read the Broken Pipeline report itself.

Young investigators appear to have the toughest time getting their research funded. Right now, Dr. Garraway's research is supported by a grant from the Department of Defense, but she hopes to generate enough data in the next two years to apply for an RO1 grant from NIH. Unless something dramatic changes in the NIH budget, however, that may be tough.

In 2007, junior researchers received only 25 percent of RO1s, down from 29 percent in 1990. So, the message sent to all of our nation's researchers, particularly those upon whom the future of American medicine rests, is that they may be better off seeking a career elsewhere, that medical progress is not a priority in America today. The question is, how long can we expect them to wait for real funding before they begin reconsidering their career options? According to the report, today's researchers are waiting an average of four years longer than they did in 1990 for their first big grant, and 43 is now the average age of first-time RO1 recipients.

What will happen when America's brightest young researchers start taking that message to heart, as many already have? NIH Director Elias Zerhouni has warned that without effective national policies to recruit young scientists to the field and support their research, in 10 to 15 years the United States will have more scientists older than 65 than younger than 35. He has noted that "this is not a sustainable trend in biomedical research and must be addressed aggressively."

There are signs that the message is getting through — at least in Congress. Only days after our report was released, the Senate approved by a vote of 95-4 an amendment to next year's budget that would increase NIH funding by $3 billion — or more than 10 percent. The resolution is merely a blueprint and it's unlikely increases of that magnitude will come about. We need leadership from the White House as well to make these increases real. So it's incumbent upon all of us to press the 2008 presidential candidates to place funding for basic and clinical research at the top of their domestic policy agenda. If not, we jeopardize the careers of a generation of researchers whose work could lead to medical breakthroughs that would dramatically enhance and extend lives.

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