National Institutes Of Health Support Research Articles

An evaluation of programs to support new investigators at the National Institute of Allergy and Infectious Diseases: Striking a balance with funding for established investigators

As the largest funder of basic biomedical research in the US, the National Institutes of Health (NIH) has an interest in maintaining a sustainable, productive workforce of investigators. Over the years, NIH has implemented several programs to attract early-stage investigators and other applicants without prior NIH support. The latest of these is the Next Generation Researchers Initiative. These programs have been shown to be successful in meeting NIH-wide goals but their success for any particular NIH institute or center (IC), and in any particular year, is determined by a variety of factors, some extrinsic to an IC’s funding decision process. Each IC must balance support for new investigators with funding for productive ongoing programs of research. We examine historical trends in support of new investigators at the National Institute of Allergy and Infectious Diseases (NIAID) over a 22-year period, as well as trends in some major extrinsic influences on that support. The results indicate that NIH’s new investigator programs have succeeded in maintaining a balance between the support for new NIAID investigators while also continuing to support an expanded pool of established investigators. The programs have been particularly effective in providing support to early-stage investigators.

Biomedical Citizen Science at the National Institutes of Health

The National Institutes of Health (NIH) is the largest funding agency for biomedical and behavioral research in the United States, supporting basic, translational, and clinical research to drive discoveries and knowledge that enhance health, lengthen life, and reduce illness and disability. The NIH invests in research that runs the gamut from basic biological mechanisms to innovative device development; environmental public health; and behavioral, implementation, and population sciences. Citizen science methodologies and approaches have broadened opportunities for public involvement across the full spectrum of biomedical research. The NIH has a long history of supporting citizen science and public-partnered research. It is challenging to estimate the investment that NIH has made in citizen science given the diverse fields, program types, and project organization that NIH-supported citizen science exemplifies and the expansion into related disciplines. The common thread through these diverse programs is a meaningful partnership with the public as direct collaborators and participants. Here, we describe unique examples of successful biomedical citizen science and community-engaged research projects that are hosted by NIH or that have received NIH support, and highlight the different terms used to encourage and report on citizen science and related methodologies.

A new era in global climate change and human health research funding and action – NIH

Background: The U.S. National Institutes of Health (NIH) have supported climate change and health-relevant research for decades. Through the years 2010 to 2020, annual NIH support for climate change and health research hovered around $10 million funded by 21 NIH components. The NIH Climate Change and Health Initiative, launched in 2021, is an NIH-wide effort to develop the first coordinated NIH plan for research on the impacts of climate change on human health. Methods: The Initiative created a core framework in 2021 that was informed by a month’s long planning and engagement process. Directors of seven Institutes and Centers at the NIH have joined together to create a strategic framework document that highlights the core focus areas of the work. The group released a Public Request for Information to gather input from community organizations and academic scientists and conducted a federal and international landscape assessment to map out organizations working in the space. Internally, NIH conducted a portfolio analysis of funded climate research from the past decade, engaged staff through workshops, and developed an internal data call for planned climate related programs. Results: The strategic framework will guide a community of practice comprising outstanding and committed scientists, trainees, and specialists. Key areas of interest outlined include: Health Effects Research, Health Equity, Intervention Research and Training and Capacity Building. The framework also identifies nine key areas of supporting science for climate change and health research. Conclusions: Climate change is impacting health and communities around the world but there remain many key research knowledge gaps. NIH’s role as a leading funder of biomedical and human health research can play an important role in coordinating research to better understand health impacts, health adaptation, and outcomes in communities impacted related to climate change. There is perhaps no greater opportunity for NIH to fulfill its mission than by providing global leadership in the response to the burgeoning climate change and health crisis. Key words: Climate change; public health; research

Experts say that funding for cancer research is at risk during the pandemic.

Over the past 5 years, the US Congress has approved an increase of $11.6 billion, or approximately 39%, for the National Institutes of Health (NIH) budget, which has enabled significant research funding. However, with the arrival of the coronavirus disease 2019 (COVID-19) pandemic, experts say that future funding and medical research progress are now at risk. “The consequences of the pandemic on the entire medical enterprise are extremely concerning for the medical research community,” says Jon Retzlaff, MBA, MPA, chief policy officer and vice president of science policy and government affairs for the American Association for Cancer Research. “It's why we've been advocating for $15.5 billion to be included in the next COVID-19 relief supplemental appropriations bill.” The financial challenges that universities and medical centers have been experiencing as well as significant disruptions in laboratory and clinical research during the pandemic have all taken a toll and led to lost research opportunities, he says. Researchers are concerned that they could lose entire germ lines and mouse colonies and that fewer patients have enrolled in clinical trials. Meanwhile, many laboratories and most supplemental government research dollars have been redirected toward COVID-19 research. According to Retzlaff, of the $15.5 billion requested for the NIH, $10 billion is needed to offset the expenses associated with research disruptions that have occurred during the pandemic. At press time—shortly before Election Day—he did not anticipate that Congress would approve a COVID-19 relief appropriations bill until after the presidential election. In addition, he and fellow medical research advocates requested a $3 billion increase in NIH's fiscal year 2021 budget to continue the institutes' robust research efforts. He praises leaders in both the Senate and the House, specifically Senators Roy Blunt of Missouri and Patty Murray of Washington and Representatives Rosa DeLauro of Connecticut and Tom Cole of Oklahoma, for championing NIH support over the past 5 years. Although he is optimistic that the NIH will see another significant increase in fiscal year 2021, he recognizes that many challenges remain. Currently, the National Cancer Institute (NCI) has a 10% success rate, which means that only 1 in 10 reviewed grant applications are being funded. “Prior to the pandemic, the rate of applications being submitted to NCI was at a pace we've never seen—there was incredible momentum and excitement,” Retzlaff says. He adds that, like other private research funders, the American Association for Cancer Research has experienced a reduction in donations, which has left it with a lower funding capacity and has made it even more imperative for the federal government to step in and provide assistance. To that end, approximately 500 people representing nearly every state participated in the virtual Rally for Medical Research Hill Day on September 17, 2020. Participants included health care providers, researchers, clinicians, caregivers, and survivors, who held some 400 meetings with Congressional representatives. The event was the largest and most inclusive since Hill Day first launched in 2013. These groups will continue working to remind Congress that medical research into major diseases needs to remain at the forefront, Retzlaff says. “Cancer and heart disease are still the number 1 and number 2 causes of death, and we can't afford to take our eyes off the ball.”

NCI support for pediatric radiation therapy: Past, present, and future.

NCI support for pediatric radiation therapy: Past, present, and future.

National Institutes of Health Support for Clinical Emergency Care Research, 2015 to 2018

I determine the most recent data on National Institutes of Health (NIH) support for clinical emergency care research. A search of the NIH category of emergency care from 2015 to 2018 was conducted, using a clinical focus and excluding animal and bench research projects, as well as career development grants. During the study period, the number of new emergency care projects submitted to NIH increased from 373 in 2015 to 434 in 2018. A total of 403 new applications were funded for $161.9 million, with an overall success rate of 24%. The total amount of support for both new and existing projects during the 4-year study period was $263 million. The number of funded R01 grants increased from 17 in 2015 to 32 in 2018, with an overall success rate of 21%. There were fewer emergency care grant submissions than those for other similar-sized disciplines. During the 4-year study period, emergency care research increased, but the number of grant submissions remains low.

National Institutes of Health Support of Digital Health Behavior Research.

The National Institutes of Health (NIH) has increasingly supported research in digital health technologies to advance research and deliver behavior change interventions. We highlight some of the research supported by the NIH in eHealth, mHealth, and social media as well as research resources supported by the NIH to accelerate research in this area. We also describe some of the challenges and opportunities in the digital health field and the need to balance the promise of these technologies with rigorous scientific evidence.

Assessment of Prevention Research Measuring Leading Risk Factors and Causes of Mortality and Disability Supported by the US National Institutes of Health

No studies to date have examined support by the National Institutes of Health (NIH) for primary and secondary prevention research in humans and related methods research that measures the leading risk factors or causes of death or disability as outcomes or exposures. To characterize NIH support for such research. This serial cross-sectional study randomly sampled NIH grants and cooperative agreements funded during fiscal years 2012 through 2017. For awards with multiple subprojects, each was treated as a separate project. Study characteristics, outcomes, and exposures were coded from October 2015 through February 2019. Analyses weighted to reflect the sampling scheme were completed in March through June 2019. Using 2017 data from the Centers for Disease Control and Prevention and 2016 data from the Global Burden of Disease project, the leading risk factors and causes of death and disability in the United States were identified. The main outcome was the percentage of the NIH prevention research portfolio measuring a leading risk factor or cause of death or disability as an outcome or exposure. A total of 11 082 research projects were coded. Only 25.9% (95% CI, 24.0%-27.8%) of prevention research projects measured a leading cause of death as an outcome or exposure, although these leading causes were associated with 74.0% of US mortality. Only 34.0% (95% CI, 32.2%-35.9%) measured a leading risk factor for death, although these risk factors were associated with 57.3% of mortality. Only 31.4% (95% CI, 29.6%-33.3%) measured a leading risk factor for disability-adjusted life-years lost, although these risk factors were associated with 42.1% of disability-adjusted life-years lost. Relatively few projects included a randomized clinical trial (24.6%; 95% CI, 22.5%-26.9%) or involved more than 1 leading cause (3.3%; 95% CI, 2.6%-4.1%) or risk factor (8.8%; 95% CI, 7.9%-9.8%). In this cross-sectional study, the leading risk factors and causes of death and disability were underrepresented in the NIH prevention research portfolio relative to their burden. Because so much is already known about these risk factors and causes, and because randomized interventions play such a vital role in the development of clinical and public health guidelines, it appears that greater attention should be given to develop and test interventions that address these risk factors and causes, addressing multiple risk factors or causes when possible.

Online, cross-disciplinary team science training for health and medical professionals: Evaluation of COALESCE (teamscience.net).

The National Academies of Sciences (NAS) emphasize the need for interdisciplinary team science (TS) training, but few training resources are available. COALESCE, an open-access tool developed with National Institutes of Health support and located at teamscience.net, is considered a gold standard resource but has not previously been evaluated. COALESCE launched four learning modules in 2011. The Science of TS (SciTS) module, an interactive encyclopedia, introduces foundational concepts. Three scenario-based modules simulate TS challenges in behavioral, clinical, and basic biomedical sciences. This study examined user characteristics, usage patterns, and effects of completing the four modules on TS knowledge, attitudes, and skills. Repeated measures ANOVA tested for pre-post changes in performance and compared learning by users with biomedical versus other disciplinary backgrounds. From 2011 through 2017, the site attracted 16,280 new users who engaged in 6461 sessions that lasted more than 1 min. The modal registrant identified as working in a biomedical field (47%), in an academic institution (72%), and expressed greater interest in the practice than the SciTS (67%). Those completing pre- and post-tests (n = 989) showed significant improvement in knowledge, attitudes, and skills after taking all scenario-based modules (p < 0.005); knowledge and attitudes were unchanged after the SciTS encyclopedia. Biomedical and other health professionals improved comparably. Evaluation of the TS training tool at teamscience.net indicates broad dissemination and positive TS-related outcomes. Site upgrades implemented between 2018 and 2020, including adding five new modules, are expected to increase the robustness and accessibility of the COALESCE training resource.

Children and Adults With Rare Diseases Need Innovative Medical Devices.

Rare diseases (RD) affect approximately 30 million Americans, half of whom are children. This study is the first to comprehensively evaluate their medical device needs via a survey of physicians. The study sought to identify and document the presumed unmet diagnostic and therapeutic device needs for RD management; clarify the magnitude of the potential unmet need; and generate meaningful data to inform medical device stakeholders. A cross-sectional nonprobability survey was conducted. The study population was drawn from the membership files of four groups: FDA Medical Devices Advisory Committee, Pediatric Advisory Committee, Pediatric Device Consortia, and National Institutes of Health (NIH) Rare Diseases Clinical Research Network. Only physician respondents with experience or knowledge regarding RD were eligible. Among eligible respondents, 90% confirmed the need for innovative devices to care for people with RD. Over 850 device needs were identified for 436 RD, with 74% of needs related to children. Pediatric physicians (OR = 2.11, 95% CI 1.01-4.39, P = 0.046) and physicians with more RD experience reflected greater dissatisfaction with existing devices (OR = 4.49, 95% CI 2.25-8.96, P < 0.0001). Creation of entirely new devices is the top recommendation for mitigating needs. This study demonstrates a major public health need for innovative medical devices to care for children and adults with RD. FDA and NIH support and seek opportunities to accelerate device development for these vulnerable patients.

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery.

The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding. The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships. Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments. There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.

The NIH’s Funding to US Dental Institutions from 2005 to 2014

This study examines funding from the National Institutes of Health (NIH) to US dental institutions between 2005 and 2014 based on publicly available data from the NIH Research Portfolio Online Reporting Tools. Over the 10-y span, 56 US dental institutions received approximately $2.2 billion from 20 Institutes, Centers, and Offices at the NIH. The National Institute of Dental and Craniofacial Research (NIDCR) is the largest NIH supporter of dental institutions, having invested 70% of the NIH total, about $1.5 billion. The NIDCR is also the primary supporter of research training and career development, as it has invested $177 million, which represents 92% of the total NIH investment of $192 million. Over the past 10 y, about half of the NIDCR’s extramural award dollars have gone to dental schools, while the NIH has invested about 1%. There has been an approximately 10% net decrease in extramural dollars awarded to dental institutions over the past decade; however, given the year-to-year variability in support to dental institutions, it is unclear if this net decline reflects a long-term trend. In addition, there was an overall reduction in the extramural dollars awarded by the NIDCR and by the NIH. For example, from 2005 to 2014, the total NIDCR budget for extramural research decreased by roughly 4%, which represents a decrease of $20 million to dental institutions. After adjusting for inflation, the decline in funding to dental institutions from the NIDCR and NIH was approximately 30%. Although the NIDCR and NIH continue to invest in dental institutions, if the current decline were to continue, it could negatively affect the research conducted at dental institutions. Therefore, we discuss opportunities for dental institutions to increase NIDCR and NIH support and improve their capacity for research, research training, and career development.

Recent Trends in Oral Cavity Cancer Research Support in the United States

The objectives were to characterize oral cavity cancer (OCC) funding from the National Institutes of Health (NIH) with a secondary aim of comparing NIH support provided to OCC and other malignancies. NIH awards supporting OCC inquiry from 2000 to 2014 were accessed from the NIH RePORTER database. These data were used to evaluate temporal trends and the role of human papilloma virus and to determine the academic training and professional profiles of the principal investigators. Comparison of 2014 funding levels with other malignancies was also performed, controlling for incidence. Overall funding totals decreased considerably after 2009. Funding administered through the National Institute of Dental and Craniofacial Research (NIDCR) was 6.5 times greater than dollars awarded by the National Cancer Institute in 2000. During the period evaluated, NIDCR support decreased in most years, while National Cancer Institute support increased and approached NIDCR funding levels. Funding for human papilloma virus–related projects gradually rose, from 3.4% of dollars in 2000 to 2004 to 6.2% from 2010 to 2014 (P < 0.05). A majority of principal investigators had a PhD omnia solus (57%), and 13% possessed dual PhD/clinical degrees. Among clinicians with specialty training, otolaryngologists and oral/maxillofacial pathologists garnered the most funding. OCC had a 2014 funding:incidence ratio of $785, much lower than for other malignancies. There has been increased volatility in funding support in recent years possibly due to budget cuts and sequestration. The National Cancer Institute has played an increasingly important role in supporting OCC research, concomitant with decreasing NIDCR support. Our findings suggest that OCC is underfunded relative to other non–oral cavity malignancies, indicating a need to increase the focus on rectifying the disparity.

Funding global emergency medicine research-from seed grants to NIH support.

BackgroundFunding for global health has grown significantly over the past two decades. Numerous funding opportunities for international development and research work exist; however, they can be difficult to navigate. The 2013 Academic Emergency Medicine consensus conference on global health and emergency care identified the need to strengthen global emergency care research funding, solidify existing funding streams, and expand funding sources.ResultsThis piece focuses on the various federal funding opportunities available to support emergency physicians conducting international research from seed funding to large institutional grants. In particular, we focus on the application and review processes for the Fulbright and Fogarty programs, National Institutes of Health (NIH) Career development awards, and the Medical Education Partnership Initiative (MEPI), including tips and pathways through each application process.ConclusionsLastly, the paper provides an index that may be used as a guide in determining whether the amount of funding provided by a grant is worth the effort in applying.

Eulogy for the Metabolic Clinical Investigator?

A recent editorial in the Journal of Clinical Investigation by Nathan et al. (1) dwelt on the decision to cease direct National Institutes of Health (NIH) funding of Clinical Research Centers (CRCs). As the authors rightly point out, the lack of extramural support for the CRC infrastructure will doom this valuable resource for human research at academic institutions without the wherewithal to support clinical research. CRCs as they currently exist might no longer require NIH support if we already knew the entirety of human physiology as it relates to disease or if entities such as industry would fund the studies needed to understand the primary mechanisms of complex human disease. We are certain the former is untrue and highly doubtful the latter will occur. The subsequent demise of the CRCs and our diminished ability to perform complex, mechanistic studies in humans will have both immediate and long-term adverse effects on biomedical research. Support obtained by the NIH Research Project Grant (R01) mechanism will be insufficient to maintain the necessary research infrastructure. Consequently, investigators will abandon comprehensive, mechanistic studies in humans because of the costs involved. The eventual fall in the number of investigators capable of designing, conducting, and interpreting such studies threatens to make the U.S. a second-tier biomedical research environment. This is especially important for the field of diabetes and metabolism where related human studies account for a significant proportion of CRC use. Certainly, rigorous metabolic research requires meticulous control of diet and activity prior to study. Moreover, ensuring participant safety with intensive monitoring often requires extended inpatient stays. The elimination of the NIH-supported CRC system will also substantially constrain the infrastructure necessary for intensive human studies, such as those requiring tissue biopsy, vascular catheterization, and frequent sampling of the …

National Institutes of Health Support for Clinical Emergency Care Research, 2011 to 2014

I report on the results of a portfolio analysis of National Institutes of Health (NIH) support for clinical emergency care research. A targeted query was created with data-mining techniques that accessed the NIH database for 2011 to 2014. The search was constructed to have a clinical focus; animal and bench research projects, as well as career development grants, were excluded. The search results were manually reviewed for appropriateness and then analyzed. Six-hundred eighty-eight applications were analyzed. During the study period, the number of new emergency care projects submitted to NIH increased from 62 in 2011 to 153 in 2014. A total of 112 new applications were funded for $100 million, with an overall success rate of 23%. The total amount of support for both new and existing projects during the 4-year study period was $263 million. One third of the funded principal investigators were emergency medicine faculty, and their success rate for R01 funding was twice the NIH average. Emergency care research makes up 0.7% of NIH spending on new research project grants. The success rate is high for emergency medicine principal investigators conducting clinical work. The overall success rate for emergency medicine R01s is similar to that of other clinical specialties.

National Institutes of Health support for individual mentored career development grants in emergency medicine.

Individual mentored career (K) awards made by the National Institutes of Health (NIH) are an important way for medical researchers to develop their research skills. This study determined the number of individual mentored (K) awards awarded to emergency medicine (EM) faculty over a 6-year period and compared it with six other specialties. The NIH database of both submitted and funded K01, K08, and K23 applications was queried and crossed with the departmental affiliation of the principal investigator. The results were further analyzed with data from the Association of American Medical Colleges to determine the relationship between the number of awards and the size of the teaching and research faculty. From 2008 to 2013, there were a total of 45 career development submissions from principal investigators affiliated with departments of EM. Of these, 27 (60%) were successful. This success rate is the third lowest of the seven specialties in this analysis. Emergency physicians submit relatively few grants compared to the size of their faculty, and the funding rate, $1,959 per EM resident, was the second lowest of the six specialties examined. Although success rates are reasonable, EM investigators submit very few individual mentored career development applications. They should take greater advantage of this mechanism to further their research training.

Voicing an impact: who does the National Institutes of Health support for voice disorder research?

PurposeInterest in a variety of neoplastic, functional, neurological, and age-related laryngeal disorders has contributed to the development of laryngology as an established subspecialty. Funding support plays a critical role in facilitating scholarship within the field. Our objectives were to evaluate who is receiving funding from the NIH for topics relevant to voice disorders, and further describe temporal trends in grants awarded. MethodsThe NIH RePORTER database was searched for grants relevant to voice disorders. Data were further organized by PI specialty, academic department, and funding totals. Furthermore, PI scholarly impact, as measured by the h-index, was calculated. ResultsA total of 830 funded fiscal years (for 232 unique projects) totaling $203 million have supported projects examining voice disorders. A plurality of projects (32.8%) was awarded to PIs in otolaryngology departments, followed by 17.2% to speech pathology/communication sciences departments. Although year-to-year variation was noted, otolaryngology departments received approximately 15% of funding annually. Funded otolaryngologists had similar scholarly impact values to individuals in other specialties. ConclusionsThe study of voice disorders involves an interdisciplinary approach, as PIs in numerous specialties receive NIH funding support. As they receive a considerable proportion of this funding and had similar h-indices compared to other specialties involved, otolaryngologists have just as much scholarly impact despite being a smaller specialty. As speech and language pathologists also comprised a significant proportion of individuals in this analysis, enhanced cooperation and encouragement of interdisciplinary scholarly initiatives may be beneficial.

Re-contacting participants for inclusion in the database of Genotypes and Phenotypes (dbGaP): Findings from three case-control studies of lung cancer.

BackgroundSince January 2008, the National Institutes of Health (NIH) has required that all investigators who receive NIH support submit de-identified high-throughput genomic data to the database of Genotypes and Phenotypes (dbGaP). The purpose of this study was to explore the feasibility of re-consenting participants from three inactive studies, conducted from 2000 through 2009, to submit their data to dbGaP.MethodsParticipants were those enrolled in one of three prior population-based case-control studies of lung cancer who had given a DNA sample. Consent to release de-identified data to dbGaP took place via mailed forms and follow-up phone calls. Chi-squared tests were used to examine differences in re-contact and consent proportions between groups.ResultsA total of 2,471 participants were initially eligible for re-contact. Six hundred and thirty-eight participants were found to be deceased (n = 627) or did not give permission to re-contact (n = 11). Of the 1,833 remaining participants, 42.3% provided written consent, 37.0% could not be located, 13.7% verbally agreed to have their data released but never returned written consent, 5.3% refused, and 1.6% were too ill at the time of contact. There were significant differences in ability to locate participants by age, race, gender, and case-control status; however, once located, there were no differences in re-consent rates.ConclusionThis study demonstrates that while most previous study participants agreed to release data, a small proportion are opposed to submitting their data to dbGaP. In addition, it demonstrates the difficulty studies based on existing samples may have in locating inactive participants for re-consent.

Scientific approaches to science policy

The development of robust science policy depends on use of the best available data, rigorous analysis, and inclusion of a wide range of input. While director of the National Institute of General Medical Sciences (NIGMS), I took advantage of available data and emerging tools to analyze training time distribution by new NIGMS grantees, the distribution of the number of publications as a function of total annual National Institutes of Health support per investigator, and the predictive value of peer-review scores on subsequent scientific productivity. Rigorous data analysis should be used to develop new reforms and initiatives that will help build a more sustainable American biomedical research enterprise.