I have a hard act to follow, because I’m from the government, but I’ll do my best to keep you engaged.
Do any of you know how the NIH gives away money for SCI? (couple of hands raised)
Okay . . . I work at the NIH, about a block away from this hotel. I work in what’s called the extramural office. So, there’s a cabinet position called Health and Human Services. She oversees a whole raft of organizations, including the NIH.
The NIH itself is led by Francis Collins . . . who’s busy because he’s got 27 different institutes to manage. Every one of the 27 has its own culture, budget, etc.
FACTS: NIH invests about $3.3 billion annually
About 80% of this is awarded in the form of competitive grants to institutions and small businesses.
About 10% goes to research right on the campus at Bethesda, including the labs and the hospital there.
What we’re about: ensuring quality research, seizing opportunities to improve health, maintaining a diverse portfolio, considering the burden of disease, constructing and supporting research infrastructure.
We mostly fund research grants, but also fellowships to students and training grants. We fund cooperative agreements and contracts. We fund program projects and the centers themselves.
Okay. How does an idea get NIH $$$$?
A researcher gets an idea. She finds collaborators, and they develop a grant proposal, which gets delivered to us electronically. The grant gets sent to a review panel, who read it super-carefully to see if it merits further attention. Everygrant will get scored. Is it a serious question? Is it new? Are these the right people to investigate? Is the plan they have going to likely result in information not currently known?
The ones that get really high scores are the ones that the reviewers were super enthusiastic about. Eventually the institute director gets a suggestion pile from us that says what we think ought to be funded.
She’s showing a graph that shows what happened to biomedical funding between 1994 and 2012. There was a bump in 2008 (stimulus $$) and then a collapse in 2010, and it’s been flat since then. The graph also shows other sources for biomedical funding. Big contribution from pharma, and from the foundations.
What does NIH spend on SCI? $80-90 million, usually through NINDS, but also through NICHD, NIBIB, NHLBI, NIGMS, NIDDK . . .
What does NIH spend its SCI money on? Big portion on repair and regeneration, like cell therapies and scaffold therapies. They also fund a lot of bioengineering. Okay, a couple of examples.
First is model systems, looking at those places where axons do or don’t regenerate. In the ringworm (C. elegans) there are scientists who can look at a single axon and manipulate a single gene to make it grow/not grow.
Another is the kind of nerve transfers that Justin Brown was talking about earlier today . . .
They’re interested in fundamental research, disease mechanisms, discovery therapy, preclinical work . . . very, very few clinical studies. What NIH is good at is helping to plug new ideas. But many of them fail, because that’s how science works. There’s a HUGE need to fund Phase III studies, which are the one and only way to get therapies to market.
Why that gap? Because things that happen in rat models don’t work in people. Out of 18 studies that were examined, not one of them was perfectly replicated in a big evaluation project about SCI research. Replicating a study is super-difficult, a little like trying to make biscuits exactly like your grandma’s. You don’t know what you don’t know until it doesn’t work.
She’s recommending we read an editorial in Experimental Neurology called Replication and reproducibility in spinal cord injury Research. (Okay, that paper is behind a paywall, but if you’re interested here’s a link to a slide show that was presented at the Reeve-Irvine Research Center. The authors are very heavy hitters: Os Steward, Phil, Popovich, Dalton Dietrich, and Naomi Kleitman.
What can we do together? Focus on ability, whatever you do best, do it. Increase representation; stop fighting for just accommodation — fight to be heard everywhere [use the RFI process from NIH and every other place in the federal government]. Try new approaches for research, which includes reverse translation — and that means taking the successes back to animals to find out what you can that you couldn’t/didn’t look for the first time. Share data. Form teams and centers without walls. Collaborate relentlessly. Stretch $$ through sharing efforts, and widen the circle of ideas.
Q: How can we fix the way the peer review system works? What about new types of science?
A: Well, it’s slow, but it does protect taxpayer dollars . . . we have to be cautious, but peer review lets us continue. One new type of science is data sharing, which is a big priority for us right now.
Q: How much money is going to neuroprotection?
A: Very little . . .
She’s at email@example.com — ask your questions!