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Funding Nutrition Research: Where's the Money?Nutritional Sciences, Medicine, Public Health, University of Arizona, Tucson, Arizona Correspondence: Correspondence: Cynthia A. Thomson, PhD, RD, FADA, Nutritional Sciences, Medicine, Public Health, University of Arizona, Shantz Building, Room 328, 1177 E 4th Street, Tucson, AZ 85721. Electronic mail may be sent to cthomson{at}email.arizona.edu. While a great idea that can be developed into a viable hypothesis is central to the development of a meritorious research proposal, without funding, the evidence base supporting or reputing a hypothesis cannot be advanced. A wide variety of funding sources exist for nutrition research, including governmental, organizational, industrial, and intramural-based funding; however, understanding the "language" of research funding can be challenging. This review provides an overview of funding sources, guidelines for securing funding, and recommendations to support a successful application for clinical nutrition research. Nutrition professionals have long understood the importance of research in advancing clinical practice, as well as the scientific integrity of our professions. Involvement in nutrition research can be challenging for healthcare professionals, given the current demands for clinical performance both in terms of quality and quantity of work completed. Despite this, many clinical nutrition professionals are attracted to clinical research, understanding that involvement in research can not only advance the quality and efficacy of care provided to patients but also offer the individual clinician an opportunity to grow intellectually. Clinical research requires collaboration across disciplines and thus is a natural offspring of team-based clinical care. Further, as clinicians well know, the clinical practice environment is rich in hypotheses that beg evidence-based investigation. One of the greatest challenges to furthering clinical nutrition research is securing funding for such endeavors. The funding process begins with identifying funding sources but also requires the ability to match the research question(s) and hypothesis(es) with the most appropriate funding source. This review will provide guidance to the nutrition professional seeking to identify funding for research, including an overview of the current funding environment, eligible practitioners, potential funding sources, the role of research budgets in estimating funding needs, a description of the diversity in the types of grants, and, briefly, tips for successful funding of grant submissions.
There are 2 significant trends in biomedical research that are of relevance in securing funding for nutrition research in the current environment. The first is the general stabilization in government (National Institutes of Health [NIH]) funding for the past few years that has resulted due to an overall inflation in the cost of conducting research and reduced "real" dollars for research. A significant rise in employee-related expenses (ie, for healthcare insurance and other employee benefits), as well as increased fees for real estate in most U.S. markets, has been a primary factor in the demonstrated rise in clinical research costs.1 Second, and possibly a result of the first trend, there is an increasing reliance on foundations and industry for support of biomedical research.1 The fiscal year 2007 NIH budget approved by Congress provides an estimated $28.9 billion allocation for scientific research, 52% of which is specific to research project grants.1,2 The NIH research project grants' budget declined by an estimated 1.5% annually between 2005 and 2007, which, when adjusted for inflation, means spendable dollars at today's value has resulted in a reduction in research funding. Trends in nutrition research funds distributed through the NIH show that funding peaked in 2005 at 1.072 million and for 2008 is estimated to be 1.034 million dollars. Table 1 details funding trends for other topic areas of potential interest to clinical nutrition research. Of note, these data suggest that an emphasis on funding studies of obesity, septicemia, and kidney-related diseases is likely to continue. Historically, federal funding for research increased incrementally between 1998 and 2003, resulting in increased hiring of academic faculty and an expansion of academic research infrastructure at most research I universities in the United States. The most recent flatline in funding has resulted in greater competition for research funds, with an estimated 44% increase in the absolute numbers of research proposals from just over 24,000 in 1998 to well over 34,000 annually in 2003. This increase in demand for research dollars has led to a more competitive research environment, with <20% of all submitted applications receiving fundable scores and a large percentage of grants, even if funded, having to revise budgets by as much as 30%–40% as the NIH attempts to fund as many viable projects as possible.2,3
The NIH is not the only source of government funding for research; however, NIH funding far exceeds that of the Centers for Disease Control and Prevention, United States Department of Agriculture, National Science Foundation, Veterans Administration, Department of Defense, or National Aeronautics and Space Administration (human research).1 Of interest to clinicians in healthcare, the Agency for Healthcare Research Quality (AHRQ), an organization supported by Friends of AHRQ, reports an estimated loss in applied research dollars of $20 million since 2002.4 Annual expenditures for primarily patient safety research are approximately $80 million annually, yet a list of topic areas suggests that these funds have been underused in terms of research specific to nutrition care of patients. A significant rise in biomedical and public health research funding has been demonstrated for private for-profit and not-for-profit organizations and individual philanthropists in recent years.5 Influential funders include the Gates Foundation (global health), Wellcome Trust (UK), Ellison Foundation (aging research), Stowers' Institute for Medical Research (cancer and other biomedical), and the PEW Charitable Trusts (health policy research). According to the Foundation Center, an estimated 88,000 funders registered with the program support over 900,000 grants, and 20% of all foundation money is designated for health research and clinical practice.6
Before embarking on a large grant proposal, it is imperative to determine if the leader, generally referred to as the principal investigator (PI) or project director (PD), has fulfilled the academic and practice eligibility criteria outlined by funding sources. The U.S. government grants clearly define eligibility requirements.7 This is particularly relevant to clinical practitioners in nutrition in that, although almost universally funding agencies acknowledge and support research conducted by a medical doctor or doctor of osteopathy, as well as those with a PhD, and the select granting organizations will also support research submitted by registered nurses and PharmDs, much fewer support work by registered dietitians and no current federal grants support submissions by a registered dietitian unless the individual also holds a PhD. Select funding is also available and targeted for individuals enrolled in a PhD program, applying for grant support specific to the individual's doctoral training; similar support is also available for postdoctoral training.8 Professional organizations, such as the American Dietetic Association, the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.), or the American College of Nutrition, do support research led by nutrition professionals independent of a medical or doctoral degree, but these funds tend to be limited in terms of funding amount and instead foster pilot projects to support professional engagement in the research process and to develop preliminary results imperative to the success of a larger hypothesis-testing grant. However, professionals in nutrition practice may also have success by contacting individual funding agencies and challenging the professional credentials required for eligibility. This approach has proven successful. For example, both the American Diabetes Association and the American Association of Diabetic Educators have adjusted application eligibility requirements to allow registered dietitians holding a master's degree to apply for independent research awards. Another issue in terms of eligibility is the nationality of the applicant in that select grants may be restricted to those holding residency status in a particular city, county, state, nation, or continent. More specific eligibility restrictions may also exist for individual grants. For example, a grant may be designated for new investigators, young researchers, or pre- or postdoctoral students or may be gender- or ethnic-specific. Careful attention to eligibility characteristics of the lead investigator is necessary, although it should not curtail involvement in that collaboration with an individual who meets the eligibility criteria can also be an effective means of securing funds. With shrinking or limited research budgets, many organizations and even governmental funding may focus on support of young investigators or those pursuing a change in career focus. The definition of young investigator can vary widely, although generally it is defined as being within a specific number of years after doctoral training or appointment to the first academic position. Providing salary support for young professionals, or those wishing to pursue a research focus to augment their clinical training, is a cost-efficient approach to increasing the number of clinical investigators. For clinical practitioners, these salary support-based grants allow them to "buy out" clinical care time if they have support to do so from their administrator.
Governmental Funding The NIH is the primary source for governmental grants supporting nutrition research, as well as clinical trial research.8 Investigators interested in securing NIH funding should initiate the process with a thorough review of the NIH Roadmap for medical research (http://nihroadmap.nih.gov/initiatives.asp).9 This roadmap provides a focused review of where NIH is headed in terms of research priority areas. Gaining funding outside priority areas, although possible, is generally more challenging. The most recent NIH Roadmap report suggests foci in several areas of interest to clinical nutrition practitioners such as metabolomics, translational (bench to bedside) research and interdisciplinary research centers, and training initiatives to promote multidisciplinary research, including specifically behavioral sciences such as dietary intervention research (an approach longstanding in clinical practice). Further, the NIH plans to expand efforts for career development of clinician researchers, including the development of a "certification" of National Clinical Research Associate (NCRA) for qualified healthcare practitioners. Numerous institutes and centers within the NIH are involved in funding nutrition-related research. These include, but may not be limited to, the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), National Institute for Diabetes and Digestive and Kidney Disorders (NIDDK), National Institute on Aging (NIA), and the National Center for Complimentary and Alternative Medicine (NCCAM). Importantly, obesity research has gained significant attention for NIH funding in the past few years. Currently, there are over 40 program announcements that focus on research to advance our understanding of and the prevention and treatment of obesity.10 Beyond the NIH, the Centers for Disease Control and Prevention (CDC)11 also supports nutrition-related research, although of a more preventive nature in general. Centers within the CDC that potentially include nutrition research include the National Center for Birth Defects and Developmental Disabilities (NCBDD), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), and the National Center for HIV AIDS, Viral Hepatitis, STD, and TB Prevention (NCHSTP). The CDC also publishes a research guide that explicitly states the public health research needs of the nation.12 The United States Department of Agriculture (USDA) is an additional source of nutrition/diet research funding. The Cooperative State Research, Education, and Extension Service (CSREES) at the USDA provides a dynamic listing of all funded research projects, including an abstract of the research and related peer-reviewed publications.13 The current funding titles of greatest relevance to clinical nutrition practitioners are likely to be the Bioactive Food Components and newer obesity initiatives. The Agency for Health Care Policy and Research (AHCPR) houses the AHRQ, which has completed research reviews on several nutrients and bioactive food compounds. Clinicians are frequently involved in scientific review panels composed to review and provide an evidence-based synopsis of practice-based issues.14 For clinicians in healthcare practice, the care management mission of the AHRQ, "to promote the receipt of effective, evidence-based, and patient-centered care for acute and chronic conditions through research, information dissemination, tool development and promotion of policies," resonates with numerous hypotheses and patient-centered clinical nutrition projects that would be of interest to this organization. The National Science Foundation (NSF) also funds nutrition-related research, although the research funds are generally applied to basic rather than applied nutrition research, and nutrition is not listed as a specific funding area.15 Education is a stated program area for funding and as such may provide an opportunity for funding of nutrition education-specific research proposals. Funding Mechanisms. The alphabet soup of the current funding programs at the federal level is likely a deterrent for some clinicians as they embark on acquiring research funding. Table 2 describes the various terms to describe specific funding mechanisms used within the federal government. Clinicians are encouraged to visit and peruse the www.grants.gov website and specifically the Office of Extramural Research website for more detailed information.16 Selecting the appropriate funding mechanisms is essential to funding success and will also dictate the funding amount available and specific application forms, process, and deadlines to be used.
Disease-Specific Organizations
Private Foundations
Health Professional Organizations
Intramural Funding
Industry
International Opportunities
Much of the decision process in securing funding for one's research stems from the cost to conduct such research in a quality manner. Generally, it is best to generate your idea in the form of hypotheses, research questions, and aims before initiating the process of identifying the appropriate funding source. However, established researchers will have an overall awareness of funding opportunities and apply this knowledge as they embark on the development of new proposals. If the research requires a substantial budget, the opportunity to break the research idea into smaller pieces is a viable approach, particularly if aspects of the research can be clearly separated out. For example, one may wish to study the role of probiotics in enhancing clinical outcomes for patients with cystic fibrosis. The research scope may include a dietary intervention, maybe even a dose-response study with the primary focus of frequency and duration of hospitalizations for respiratory illness. This research could fall under the R01 funding mechanisms or, if it is fairly novel and previously unexplored, perhaps even R21 funding. If the statistical power estimates indicate that the required number of subjects to test your hypothesis is approximately 88 per group (treatment vs control) and you estimate the cost for a 12-week intervention to be approximately $480,000 over 3 years, then it is clear the R01 mechanism is the only one with sufficient monies to complete the project. However, another approach might be to first pilot the intervention in 40 subjects total in a crossover design (under an R21) and then to use the preliminary data generated from this research for a sequential R01 application. An alternative might be to complete the testing of a single hypothesis focused on healthcare outcomes data available standard in clinical practice (hospital admissions, International Classification of Diseases, Ninth Revision codes, length of stay) and to archive biologic samples (blood, stool, etc), as well as relevant questionnaire data (diet, physical activity, quality of life, etc) for supplemental grant applications. Budget restrictions and guidelines will significantly influence the funding decision process and as such must be developed early in the grant-writing process. Specifically, most funding agencies will request specific information and justification for all individual study personnel (including costs for related employment expenses such as medical insurance, etc), supplies (clinical, office, laboratory, etc), and equipment, travel, and related expenses (human subjects committee review, publication costs, biostatistician support, etc).
There are several research-funding–source search engines and websites that can assist practitioners in staying informed of research opportunities. Initially, a search of the government Computer Retrieval of Information on Scientific Projects (CRISP) will provide an overview of the nutrition- and diet-related research currently funded. The next step would be to visit the relevant websites for more detailed information regarding funding available through specific government institutes, agencies, foundations, etc. At www.grants.gov, individuals can enter key words into the search engine16 and receive a comprehensive listing of grants specific to the topic area entered. For example, a search using the word diet provided a listing of 37 active grant opportunities, the majority under NIH funding mechanisms. The listing includes activated web-based links to each specific funding source. Established researchers and those housed in academic institutions will frequently subscribe to an individualized funding search engine to assure e-mail–based notification of new funding opportunities specific to their research interests. These engines search for funding opportunities using key words submitted by the investigator during the enrollment process. Examples of such programs include Community of Science (COS) Funding Opportunities26 and Research Research.27 Other search engines include Grants Net, sponsored by the U.S. Department of Health & Human Services,28 and engines for behavior-related research, including dietary behavior, Decade of Behavior FundSource links.29 Other methods for staying abreast of funding opportunities include attendance at scientific meetings, professional collaborations and networking, and participation in research-related e-mail list serves. In addition, most academic institutions, particularly research I universities, will have a research office designated to support research efforts. These offices provide training in grant writing, establish search engine links for individual researchers, promote collaboration among investigators within an institution, and usually provide their own local university-based pilot funding for innovative proposals and early-career researchers.
Of course success in research funding is not solely dependent on a good match between funding agency and the individual grant. In order to receive grant funding, a high-quality, competitive research proposal must be received. Table 5 reviews some of the more pertinent issues for securing grant funding. For clinical researchers, it becomes imperative that ample time be specifically designated for grant writing and that collaboration be developed with research scientists with strong history or extramural funding success. Although detailed information regarding the writing of a fundable research proposal is not the role of the current review, it is an important aspect, and thus well-developed guidelines should be consulted.30,31
Even beyond building collaborative research relationships, identifying a mentor for the research process is critical. This may be a senior scientist(s) who is willing to review draft proposals throughout the development process or perhaps intermediate career researchers who understand and are closely engaged in the research process, and who can guide the new investigator through all aspects of the funding process. Some academic and clinical practice settings will have a fully operational mentoring system to meet this need. In other circumstances, the new investigator may need to independently develop a mentoring plan and invite select peers and superiors to be involved. Further, an essential component in securing funding for research is to develop a clear history of peer-reviewed research publications. Although this is beyond the scope of the current review, it is an essential point for success in clinical research. Many clinician researchers have the knowledge, expertise, and enthusiasm to develop and implement clinical research programs but may have limited experience, expertise, or interest in writing for professional publications. In such cases, the clinician is advised to collaborate for the development of a strong publication, as well as to consult available resources on the subject.32 1 Anonymous. Biomedical research funding in FY 2008. Physiologist.2007; 50:67 –68.[Medline] [Order article via Infotrieve] 2 National Institutes of Health. Summary of the FY2007 president's budget, February 6, 2006:10. Available at: http://www.myeloma.org/pdfs/NIHBudgetSummary.pdf. Accessed June 2, 2007.3 Mitka M. Scientists warn NIH funding squeeze hampering biomedical research. JAMA.2007; 297:1867 –1869.
Nutrition in Clinical Practice, Vol. 22, No. 6,
609-617 (2007)
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Current Funding Environment
Eligibility