Similarities and differences in philanthropic and federal support for medical research in the United States: an analysis of funding by nonprofits in 2006-2008.

PURPOSE: The medical community currently has no detailed source of information on philanthropic research funding. The authors sought to identify trends in research funding by members of the Health Research Alliance (HRA), a consortium of nonprofit funders of biomedical research, and compare findings with research support from the federal government. METHOD: Thirty-two HRA members uploaded information about grants with start dates in 2006, 2007, and 2008. Data were collected about each grant, investigator, and recipient institution. Disease categorization codes were assigned by a computer process similar to that used by the National Institutes of Health (NIH). RESULTS: In the three years under study, HRA members awarded 9,934 grants, totaling $2,712,418,254 in research and training support. Grant funding increased by 26% between 2006 and 2008. In contrast, NIH research spending increased by only 3% over the same time. Fifty-six percent of HRA grant dollars supported research projects, whereas 30% supported career development and training. During the same period, more than two-thirds of NIH grant dollars supported research projects, although NIH invested proportionally less in career development and training (7%). The largest proportion of HRA grant dollars addressed cancer, followed by diabetes and genetics. Sixty-three percent of HRA-supported investigators were men and 36% were women; 66% of investigators were white, 32% Asian, and fewer than 2% black. CONCLUSIONS: These results indicate that nonprofit organizations play an important role in developing careers and advancing research in significant disease areas such as cancer and diabetes, and in basic science areas such as genetics.

Meeting the challenges facing clinical research: solutions proposed by leaders of medical specialty and clinical research societies.

The development of a robust national clinical research enterprise is needed to improve health care, but faces formidable challenges. To define the impediments and formulate solutions, the Institute of Medicine's Clinical Research Roundtable convened leaders from medical specialty and clinical research societies in 2003. Participants considered how to influence clinical research funding priorities, promote mechanisms to train physicians and other health care professionals to conduct clinical research, and how to encourage health care providers to follow evidence-based medical practice. Consensus emerged on multiple issues, including intersociety collaboration, the need for a core clinical research curriculum for training the new cadre of clinical researchers, joint advocacy for increased funding of clinical research and for the education of policymakers and the public on the benefits of clinical research. Specific recommendations were made on mechanisms for recruitment, training, and retention of clinical research trainees and mentors. Steps were outlined (1) to overcome career disincentives and develop appropriate reward systems for mentors and trainees, (2) to encourage use of web-based and continuing-medical-education-based mechanisms to bring practitioners up to date on issues in and results of clinical research, and (3) to create incentives for individuals, clinics, and hospitals to practice evidence-based medicine (EBM). Collectively, the response and proposed strategies can serve as a roadmap to improve clinical research funding and training, evidence-based medical practice, and health care quality.

Central challenges facing the national clinical research enterprise.

Medical scientists and public health policy makers are increasingly concerned that the scientific discoveries of the past generation are failing to be translated efficiently into tangible human benefit. This concern has generated several initiatives, including the Clinical Research Roundtable at the Institute of Medicine, which first convened in June 2000. Representatives from a diverse group of stakeholders in the nation's clinical research enterprise have collaborated to address the issues it faces. The context of clinical research is increasingly encumbered by high costs, slow results, lack of funding, regulatory burdens, fragmented infrastructure, incompatible databases, and a shortage of qualified investigators and willing participants. These factors have contributed to 2 major obstacles, or translational blocks: impeding the translation of basic science discoveries into clinical studies and of clinical studies into medical practice and health decision making in systems of care. Considering data from across the entire health care system, it has become clear that these 2 translational blocks can be removed only by the collaborative efforts of multiple system stakeholders. The goal of this article is to articulate the 4 central challenges facing clinical research at present--public participation, information systems, workforce training, and funding; to make recommendations about how they might be addressed by particular stakeholders; and to invite a broader, participatory dialogue with a view to improving the overall performance of the US clinical research enterprise.