National Institues of Health (NIH) Reauthorization FY08 Appropriations

RECOMMENDATION
We support the inclusion of the following language in the report to accompany the Labor/HHS appropriations bills for FY08.

“Translational Research has been identified by the Director of the National Institutes of Health (NIH) as a road map initiative. The committee supports this effort and encourages NIH to integrate such research as a permanent component of the research portfolio of each institute and center. The committee urges NIH to begin discussions to determine how best to facilitate progress in translating existing research findings and to disseminate and integrate these findings at the practice level. Translational research should also include the discovery and application of knowledge within the practice setting using such laboratories as practice-based research networks. This research spans biological systems, patients, and communities, and arises from questions of importance to patients and their physicians, particularly those practicing primary care. The Committee requests that the Director of NIH include a progress update in next year’s Budget Justification.”

In addition, we support the Ad Hoc Group for Medical Research and others’ call for an increase in NIH funding by 6.7 percent in each of the next three years. For FY08, 6.7 percent translates to about $1.9 billion, making the total request for NIH $30.8 billion.

BACKGROUND
Historically, much of the work that has been done at NIH has not been open to the kinds of questions that family medicine researchers have been concerned about – questions that arise from their practices. We are encouraged by the development of the NIH Roadmap and the Clinical and Translational Science Awards (CTSA), along with the establishment, in statute, of a funding stream for the common fund that NIH is moving to becoming a more fertile arena for family medicine and other primary care research. However, there are major strides we believe NIH needs to make to ensure that the promise of bench to bedside research truly becomes bench to bedside to community – and back. We were able to achieve report language similar to what is included above, in the Senate FY07 Labor/HHS appropriations bill, to help define the complexity of translational research, but a continuing resolution was passed instead, so that language went no further. Why is this report language needed? Some expressions from the field regarding the need for additional research at NIH, in their own words:

University of Massachusetts, Department of Family Medicine and Community Health: As for NIH, trying to sell real-world interventions to study sections that may not be scientifically pure but answer relevant questions for improving care, remains a challenge. Many editorials have been written about the lack of applicability of much [randomized clinical trial] (RCT) evidence to real-world practice situations because the populations have been so carefully selected that they are not remotely representative of primary care patients. Furthermore, for primary care researchers, the need to choose a disease or organ and focus narrowly to succeed at NIH is quite problematic - research affecting primary care needs to focus on patients, providers, and processes… Barry Saver, MD, MPH

University of Connecticut, Department of Family Medicine: Adding more “action research”, in which the community (including, but not exclusively, the community clinicians) participates more in the definition of the problem, the design of the solution, and the dissemination and management of the results as they evolve, could augment the impact […]of the eventual findings. Rob Cushman, MD, Chair

University of Buffalo, Department of Family Medicine: I think Family Medicine would like to see more opportunities for PBRN and community based participatory research approaches to further the translation of research from bedside to patient. In parallel, current study sections are heavily weighted with bench and clinical trial researchers. Having more family medicine researchers participate on review boards will help get more of these types of grants funded. Tom Rosenthal, MD, Chair

University of Cincinnati, Department of Family Medicine: Cross-cutting research ideas, such as patient safety, become less fundable at NIH unless you concentrate on a specific content arena (e.g., cancer) and lessen the ability to focus on broad and important areas such as the human factors associated with laboratory patient safety. Jeff Sussman, MD, Chair