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Philly’s Opportunity to Address Health Disparities Through Research Funding

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R01, K, R03, T32 – navigating the world of NIH grants, especially in uncertain financial funding times, can be confusing.  Last month, Gary H. Gibbons, MD, director of the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health, delivered a keynote address to explain existing opportunities, and outlined the institute’s vision for future funding of research.

In a lecture titled “Seizing Unprecedented Opportunities: Translating Heart, Lung, Blood and Sleep Science into Public Health Impact,” Gibbons discussed how NHLBI utilizes discovery science to improve the Nation’s health.

Michael Parmacek, MD, chair of the department of Medicine, introduced Gibbons and commended him for his achievements at the helm of the NHLBI.

“Gary has been a visionary leader during some very challenging times,” Parmacek said. “Gary has made the tough choices and identified priorities that have allowed the Nation to progress.”

Gibbons explained that this progress results from balancing a portfolio spanning basic, translational, clinical, population, and community-level science with a focus on training a diverse group to develop the next generation of research leaders.

“Valuing investigator initiated discovery science is the bedrock of what we do,” Gibbons said.

This funding is associated with no short list of challenges for the NHLBI. The last couple decades have experienced increasing numbers of applicants and applications given to PhDs for R01 grants, leaving a limited pool of R01 grants available to young physicians.

While acknowledging some financial uncertainty, Gibbons cited the recent passage of the 21st century cures act as a point the optimism. Part of the NIH budget that was increased this year, the Act appropriates billions of dollars over the next 10 years on the cancer moonshot, a national research effort launched at Penn last year, a precision medicine “all of us” campaign aimed at creating a cohort of more than a million Americans, and regenerative medicine research. The act increases the cap of a loan repayment program to foster opportunities for new researchers. Gibbons also reiterated the importance of inclusion of women and minorities in clinical research.

Though funding needs are allocated to areas with the most potential for improving patient care and outcomes, the NHLBI currently is also undergoing a renewed focus towards creating opportunities for young researchers and underrepresented groups.

Despite their efforts, Gibbons noted that over the past decade, he has seen some concerning trends.

Among R01 applications, the NHLBI has seen a dramatic rise in applications from PhD scientists, while the number from MD or MD/PhD investigators have remained relatively flat.

“This is a challenge, and within the same period of time, the NIH budget has been flat – if you consider inflation, it has eroded,” Gibbons said.  

The trend leaves more applicants chasing the same amount of money, creating a highly competitive pool.  To compensate for this, the NHLBI has been working towards reorienting more money to the R01 pool, i.e., to support a “discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing the investigator's specific interest and competencies,” to expand the number of awards they can give.

Looking at AAMC data, Gibbons also expressed concern about declining numbers of tenure track faculty positions for clinician scientists across the United States. Also, because a significant portion of R01 funding goes to baby boomers, that allows for fewer opportunities to early career researchers. The NHLBI is working towards partnering with academic medical centers to help young researchers get that first position and have a solid footing on which to begin their careers.

One solution Gibbons suggested is expanding the pool of K awards—which are essential for young faculty members to start their careers as independent investigators—to create more opportunities for young researchers.

Gibbons added that diversity and inclusion initiatives are critical, noting that black applicants have a 10 percent lower chance of being R01 funded than whites. This may relate to differences in backgrounds, mentorship, or unconscious bias.

The NHLBI utilizes multiple diversity initiatives to address this disparity, including the Build program (a national mentoring network), the Pride program (which invests millions of dollars each year for postdocs and young investigators of underrepresented groups for mentorship to nurture their success), and a diversity-focused K award.

Among females, there is much higher success at the K level than there is at the R level. Gibbons suggested further research into what is causing that and ways to remedy gender disparities in that transition from serving as a K–funded researcher to getting a first R01 job.

Whatever causes the disparities between race and gender, Gibbons says the NIH is working to identify ways to combat them. 

Gibbons is hopeful that the next generation will use tools in imaging, nanotechnology, data science, personal sensor technology and transform systems biology, to shape future discoveries in care for patients with chronic diseases, regenerative medicine, precision medicine, and health inequities, among other areas.

Noting that the event was sponsored by the Special Interest Group on Health Disparities and Health Equity, and in partnership with the department of Medicine and the Penn Medicine Office of Inclusion and Diversity, Gibbons noted that Penn is in a unique position to be an asset in these efforts.

“In many ways, because of the makeup of Philadelphia, I think Penn is poised to fulfill the principle to innovate an evidence-based illumination of health inequities—making this a model city that can be a beacon for the rest of the Nation and the world.  We’re here to stand by you as a partner.”

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