Shortcomings of the Current Medical Research Grant System

The National Institutes for Health (NIH) grant system for medical research was put in place to provide funding for impactful, often life-saving discoveries. Certain aspects of the system, however, appear to come up short.  

When accounting for inflation, the amount given by grants each year must increase just to remain on par with the year prior. According to a study from JAMA, research funding in the US only increased 0.8% each year from 2004 to 2012. Falling behind the rate of inflation, this lack of increased funding has cost the NIH to lose 23% of its purchasing power in the past 12 years.  

Changes in funding is long overdue. Funding is harder to find in general, and the current approach favors low-risk research and proposals by older scientists and white men. Why the Medical Research Grant System Could Be Costing Us Great Ideas https://t.co/J8MB5823YL

— Maricel Maffini 🌻(maricel_maffini in Threads) (@mvmaffini) June 18, 2018

RO1 Grants Indicator of Medical Research Success?

As a result, it has become increasingly difficult for researchers to get funding. The average age of a researcher with an M.D. who receives a R01 grant is 45 years of age. R01 recipients are much more likely to obtain tenure and promotions, as well as being among the few and prestigious researchers able to get such funding. This intense competition has potentially weeded out talented researchers, with only 20% of doctors who aim to become a tenured researcher achieving their goal. This is understandable if the minority group achieving this status are truly elite and superior to those who do not make the cut, however studies have brought into question the efficacy of this elimination process.  

This study took 25 research proposals from the National Cancer Institute and gave them to researchers. All the proposals had been accepted for funding, with 16 receiving funding after their first submission, and 9 after the second. The researchers underwent the same conditions as the NIH evaluation process, meeting in groups and discussing how they would score each proposal.  

Intraclass correlation was found to be 0, meaning that there was no agreement on application quality. Kripendorff’s alpha scores were all very close to 0 as well, indication the same lack of agreement. Scores for the same proposal were also found to have similar lack of agreement as those of different proposals. Discrepancies in scoring did not vary significantly for proposals accepting on first and second submission either. Granted, each of the proposals reviewed successfully achieved funding, and were therefore part of the small minority of submissions that get accepted; however, the disparities in these results is still very concerning.  

“There’s no doubt that having a bounce back — an increase in our funding — would be helpful,” – Dr. Harold Varmus

Favoring only a small number of experienced researchers conducting low-risk research, the current medical research fund put in place by the NIH is struggling. Increasing its funding provided each year at a rate roughly half that of inflation, grants given out are becoming both scarce and extremely competitive. If this trend does not change, its shortcomings will only escalate.  

Sources: New York Times,  NPR, Youtube