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layout: post title: “Notes on the book ‘How the NIH Can Help You Get Funded’” toc: true image: https://source.unsplash.com/OfMq2hIbWMQ tags: - “physician-scientist” - “academic writing” - funding

- “career development”

How the NIH Can Help You Get Funded

Mike Becich is a wonderful researcher and entrepreneur, and chairman of the Department of Biomedical Informatics at the University of Pittsburgh. I met him on the residency and fellowship interview trail, and, among other things, we talked about grant strategy and how to build a career doing research in biomedical machine learning/informatics/data science/etc. He was kind enough to give me a copy of the book <ins>How the NIH Can Help You Get Funded</ins>, which is exactly what it sounds like: a how-to and strategy book for academic research scientists, most of whom depend on funding from the National Institutes of Health to support their work and salaries. The book is a publication of Oxford University Press and also available from Amazon.

These are my notes from and synthesis of this book. The synthesis was made by going through my notes and extracting things I thought were key and may be useful for quick review; the full notes I took as I was reading are copied below that.

If you notice any mistakes, misconceptions, or flatout wrongheadedness, please shoot me an email. Also, though the general outline of how the NIH works is fairly stable, specifics change from year to year and this book, as with almost every book of its genre, was outdated upon publication. It will be at least a few years before I apply for funding, at which point an even larger number of specific details will be out of date, so what I am looking for is general strategy and key history.

Synthesis

This book is a bit hard to summarize, as it has a mix of very practical and technical information, with general guidance, strategy, and advice (to use the parlance du jour, strategy and tactics). I figured this would be the case going in, hence this public store of notes that I can quickly review.

Some general things: - The NIH is about science, but is run by, and full of, people. These people have personalities, hopes, fears, egos, soft spots, families, and digestive systems. If you keep this front of mind as you communicate your science, you'll have a Good Time. - Of all the people at the NIH, your main points of contact are the Program Officers (POs). It is a completely sane and compassionate approach to try and make their lives easier. Also realize that their job is to build a portfolio of cool and important work for their organization, and that they often had prior lives as PIs themselves. So do your homework, know what stresses and timelines they are under, and do your best with your science and your personal communication to develop a relationship of mutual respect and care. - Also think of your proposal itself as building a relationship with all its readers - you want to be nice to them (make it easy to read and rate - many specific tips and tricks herein), and to make it exciting and fun to imagine what success will look like for your project, the team, the institution that is considering sponsoring it, the patients who will benefit, and the world at large. (Don't resort to corporate technobabble BS, as this makes it less fun/very irritating to read). - The NIH is also a government organization, and is therefore subject to all manner of red tape, budget constraints (and cuts), fickle bureaucrats, and delays. If you know the timelines and possibilities going in, you'll have a Better Time than You Would Otherwise. - The R01 Holy Grail makes more sense to me now, since going through this book while also talking to friends who are early in their careers as physcian-scientists. The grant is attached to you, not your institution. You have a large amount of freedom to do what you want with it (with the exception of a small number of funding mechanisms, the NIH pretty much gives you money and gets out of your way - you have to show productivity, but exactly how you accomplish that is your choice). It can be renewed, and this renewal is a bit easier if you're an early investigator. If you want to be a physician-scientist, having funding will let you lighten up on the patient load. You can also hire brilliant people, and having the R01 is a draw for top talent. - R01 is a pretty good way to fill 2/3 of the triumvirate of what makes careers happy: competence/expertise (you are by definition an expert in your field), autonomy, and relatedness (you bring this - a sense of connection to the people you work with and for, and the cause). - The “publish or perish” thing makes more sense to me now as well. Tenure seems to be going away at many institutions, or is veryveryvery difficult to get, so a researcher's life is a never-ending cycle of applying for grants that have a government-mandated average length of 4 years. If you want a renewal, or a successful new grant, you have to show productivity. Though there is some understanding that certain kinds of work take a long time to bear fruit, you basically have to have first and/or last author pubs in decent-to-good journals rolling out with some consistency to remain competitive. This book helped me own my identity as a physician-scientist (in training), and all the trappings that go with it, including the high likelihood that I will live most of my career on these funding cycles. - Speaking of owning my career, the book also makes me curious about non-NIH funding mechanisms, e.g. through other govt orgs or third parties. This book mentions some, including the Dept of Defense and National Science Foundation. If anyone has suggestions for places I should check out that may be conducive to a research career in bioinformatics/data science/machine learning for medicine, particularly blood cancers, with major interests in healthcare disparities and community/population health, shoot me an email. I also want to see patients, so certain industry careers may be out - but I know that industry is also a complex and varied space, with as many shapes of careers as there are individuals, so would be open to hearing about those avenues as well. - As I finished this book I was also overwhelmed with gratitude to my undergraduate alma mater, Brigham Young University, for giving me singular opportunities for research across the institution that led me to a career in research, to my medical school alma mater, Cleveland Clinic Lerner College of Medicine, for setting me up to be successful, by giving me time and headspace to think about which skills I wanted to develop, plenty of support to get a head start on them, and mentors in every conceivable area. Next, I am so, so excited and grateful for Vanderbilt University Medical Center and the Harrison Society for welcoming me into their fold. The clinical training will be fantastic, and the way they set up their physician-scientists for success (== R01 and other funding mechanisms) occupies a truly rarefied place among academic institutions in the United States. I'll admit I'm scared of the publish-or-perish thing still, but knowing there is a staggering level of support and deep precedence for success helps assuage the imposter syndrome and insecurity. - Overall, I'm glad I read this book, and am grateful to Becich and other mentors and friends in science and medicine for getting me to think about the arc of my career and how to increase the likelihood of success. The timing was great (Spring 2020), as I will be entirely engaged in the practice of clinical medicine for the next 2-4 years before jumping back into research. I will likely revisit this book or its successor, as well as these notes, as I scan the horizon for opportunity and learn, as I practice clinical medicine, where help is needed most.

Notes

National Institutes of Health

This chapter provides a background on the NIH. - NIH = 27 Institutes and Centers (ICs) - began in 1937 with the National Cancer Institute (NCI), then in 1938 cornerstone laid for NIH campus - part of executive branch, but Congress authorizes and appropriates funding - budget grew ~2x from 1998-2003, but then failed to keep pace with inflation or dropped. This is problematic because ICs would like to plan for multiple years ahead and provide stable commitments to researchers doing important but longer-than-a-year research. The payline (the score and percentile at which grants are funded) is subject to variations in appropriations. - budget allocation (rough percents): 80% extramural funding, 11% intramural funding, 5% salaries/admin, 2.5% formal training programs (80+11+5+2.5 = 98.5%) - Program Officers (POs) are extramural staff associated with each I/C. The authors make the point first here, and repeatedly throughout the text, that applicants should contact their PO at each stage of the application, review, and award process. - Office of the Director: coolest thing here is the Office of Strategic Coordination's Common Fund Programs, including the NIH Director awards. These fund cross-cutting, high-risk, possibly high-yield projects (see here for current highlights), touting the program as the “venture capital” space within the NIH. Some of the data science-y stuff funded by the NIH was/is via the Common Fund, e.g. development of a data commons. The language is purposefully obtuse, matching the tone of Silicon Valley VC, as I think it has to be when they are looking for (again, purposefully) underspecified opportunity to fund interesting work that doesn't quite fall under any IC purview but has potential to be generally useful. - A “grant” is different than a loan, contract, or cooperative agreement. The idea is for the IC to determine if your proposed project fits within their strategic plan to have “significant and lasting impact on the field and public health,“ and then they get out of the way to let you carry out your plan as you see fit, and evaluate your productivity and promise as you apply for renewals, etc. - This jives with what I learned early on in anthropological/ethnomusicological research: it is widely understood that everything might (will) change when you get in the field, but funding and approval bodies need to see evidence of innovation, possible impact, and careful thought before they hand out money and rubber stamps. You then have freedom to do your work as best you know how, and react to unexpected realities as you see fit. - Contracts are for specific needs (e.g. developing an animal model, operating a facility); cooperative agreements are similar to grants but involve substantial “scientific or programmatic” involvement from the federal government (i.e. they are less independent). - At this point, the rest of the book is summarized and a timeline is given. The timeline is a concordance of the timelines of Congress, the ICs, the principle investigator (PI), and the standard funding opportunity announcements.

Institutes and Centers

Center for Scientific Review and the Peer Review Process

Getting at Mechanism

Aha! This is part of why I picked this book. I've always been curious about the specific mxns the NIH uses, and when to use which. - R01 - ~½ of extramural NIH funding is R01 - up to 5y length - average length mandated to be 4y, and new and early stage applicants more likely to get 5y award - when you are no longer early or new, then proposing work with shorter time frames is a bit sexier and more likely to get funded - renewable - favors early state investigators (reviewed in their own group, also can reapply within the same funding cycle) - R21 - “starter” grant - success rate actually lower than R01, d/t large number of increased applications - NIH recommends that the R21 not be used as an entry for junior investigators, because: - cannot be renewed - generally limited to ~$275k over 2y - no payline break for new or early applicants - kinda seems like one to avoid, overall - what are the upsides? Not clear from this reading. - R03 - “Small research grant” - $50k per year for 2y, nonrenewable - time limited, focused - e.g. collect pilot data, perform data analysis, develop assay or model - sometimes limited to K awardees and new investigators - sometimes used to respond to reviewer concerns for R21s, so it would be a (long path) R21 application -> R03 application -> R03 award -> R01 application and award - R13 - Conference awards, supports specific costs, usually less than $20k (???) - Needs letter from IC R13 PO - 60% success rate - R15 - Academic Research Enhancement Award (AREA) - Limited to academic components w/in institutions with < $6m in funding from >=4 of the past 7y. - $300k direct costs over 3y, renewable - Seems like a mini-R01 for early researchers at underfunded/newer programs - R33 - 4 offered per year. - Phase II for successful R21. - Often solicited by funding opportunity announcements and ICs. - Milestone driven (must be quantifiable) w/ Gantt chart or similar timeline - R34 - Clinical Trial Planning Grant (phase III trials) - E.g. data collection tools, manuals, recruitment strategies, data sharing and multiple IRB submissions if multisite, also pilot studies

Small business grants - Small Business Innovation Research (SBIR) R41 and R42 - >=40% of the work performed by small business, >=30% by a nonprofit research institution, rest either split or include a third party - Small business Technology Transfer (STTR), R43 - Primary PI primarily employed by small business. >=67% of the work performed by small business if phase I, >=50% if phase II.

P grants - Program projects (P01) or Center (P20, P30, P50, P60) - Themes that would benefit from collaboration, and would be unlikely to be successful otherwise - Emphasis on supporting new and nontraditional researchers - Could be basic or have a clinical component - Need a large number of R01 and other awards to justify, and if you are interested in starting one of these work closely with the PO

K awards - Career Development Awards - Setup: - Award is both for the work itself (e.g. specific aims) and to prepare the investigator for R01, so write it this way - emphasize how the training and mentorship will not only make the project more likely to succeed, but will also set you up for a successful career in your field - This sounds a lot like the ASH awards, with similar strategies: - make sure your primary advisor is going to be an actual advisor, not just a big name on the proposal (the reviewers will probably know if this is the case, and you would be seemingly paradoxically less likely to get the award) - go ahead and have that big name as a secondary advisor/part of an advisory panel, and use their expertise to get a broad view of the field and how to succeed in it (if they have time for specific mentoring, gravy) - write in the first person, about your career goals and accomplishments thus far - start the Candidate section with your long-term goals, to frame the conversation and show the reviewers that you are going somewhere - acknowledge your gaps and show how the K award will help you fill them - if you have no major gaps, go for the R01, not the K - have great letters from your mentor and advisory team, that you participate in writing, showing a personalized recommendation and plan, and the qualifications of the mentor(s). Make sure the details in the letters all jive. - Have some first author papers, to the extent possible (reviewers are understanding if you are a clinical scientist and stuff takes forever to get to the manuscript phase) - A collection of poster presentations that never -> manuscript is a bad look - Review papers are +/- helpful, depends on the journal, but might be useful to show commitment to and understanding of the field - The grant itself: - Less is more, be ambitious and innovative but realistic about what can be accomplished in the time frame - All the Ks: - Different ICs use the same codes for different things, so check the K Kiosk at the NIH website. - But generally: - K08, K23, K24: applicants with clinical degrees - K01, K02: basic scientists - K01, K08, K23, K25: junior investigators - K02, K05, K18, K24: established investigators - K22, K99/R00 (kangaroo!): postdocs (also needs academic appt during award, and need to submit R01 before end of 2nd year of the 3y award). K99 while a postdoc, then R00 activated when faculty appt received - K12: clinical research career dev, established PI submits application to NIH then trainees compete for slots. Coupled with intensive training and resources (similar to the PSTP programs, with biostats support, grant-writing committees and extensive pre-review, etc.) - KL2: similar to K12, Clinical and Translational Science Award (CSTA)

F and T awards - F: fellowship, T: training - Like Ks, but required to pay back 1y of support through research and teaching (not patient care). - Can be obtained predoctoral (e.g. MD-PhDs in training - up to 6y) or postdoctoral - up to 3y.

Summary: Tons of alphabet soup. Most of us will focus on R01 and ways to get to R01 (K,F,T, maybe R21/R03). For more specific stuff, it's always changing anyway, so look it up and talk to your PO.

Telling Your Story Well

Institute Approach Significance Innovation Investigator Environment N
NCI 0.80 0.67 0.59 0.53 0.45 5396
NHLBI 0.82 0.67 0.64 0.56 0.48 3157

Getting by with a Little Help from Your Friends

Before and after Your Study Section Meets

Is the Check in the Mail?

The Check is Not in the Mail…

The Check is in the Mail, but…

Appendix