Presidential funding
F Xavier This
is the first year of the fourth for Clinical
that the society number
which
great
research
Nutrition
is doing
of our
bership dentials
of The
You
have
very well. Dr Monsen is growing
and that we have
today: first, through second, because
its members;
and
However,
third,
the very
rate
committee
now
(for
deserve
reached
a total
a
achievements
retains its crcsociety in
for of
ofthe
counted
as a champion
United
States
of the society
and as such
of clinical
and the education
must
research,
and training
have
brought
stand
up and be
nutrition
investi-
academic
clinical
offuture
nutritionists. Clinical of trouble
nutrition achieving
specialty. It has had a great deal as an entity in itself and tends
is a difficult recognition
to be lumped as a part of one of the other clinical be it gastroenterology, hematology, endocrinology olism,
or nephrology.
its own
identity
It has,
and
pitals,
clinics,
and
trition
has not been
places,
there
being
who
recognized
reimbursement recognized
has been
investigators
as a result,
providing a high
regard
medical school is over and done, few are interested in pursuing
been
we who specialty.
a formidable funding tioned Am
and
iC/in
Yet
issue today
the society
challenge.
at the
National
to the membership Nuir
entering
interest
for nu-
the residency it as a career,
are in it know that it is an interesting and How do we broadcast this far and wide?
The most important on them.
nu-
for young
Although
by the time have
hos-
clinical
role models
options.
students
build
schools,
in most
career
199 1;53:397-8.
This
is to maintain
our gains
and
and the discipline
are faced
with
challenge
Institutes
is the crisis
of Health
in my President’s Printed
in
USA.
(NIH). Column ©
for nutrition The
their budgets. nutrition
and
other
The whole
research,
13.4% of its Center-grants
institutes and
budget
spend
a much
spent
only 4.2% of its budget
NIH
it is important
ofprojects called nutrition in them and are certainly
and
of Diabetes (NIDDK), the lead institute 1 1 .3% of its research-grant
and Kidney Diseases research, spent only
projects
smaller
to point really
not being
have
carried
out that very
for
amount
of
on
a number
little
nutrition
out by clinical
nu-
1991
in research As I menin Nutrition American
The crease there. Heart, Cancer award about
fiscal
Society
1990 budget
The projected payline for ROls for NIDDK, the National Lung and Blood Institute (NHLBI), and the National Institute (NCI) will be about a 150 priority score with rates of about 24%, 19%, and 29%. NIH will fund only 4800 new and competing grants during FY 1990, down
from
nearly
of 3. 1% in NIH
6500
in FY
from the president funding,
1987.
so there
As of today,
only is no
allows
an in-
breakthrough
the expected
figure
for FY 1991 will be 4600 new grants. In addition, NIH is cutting each grant as much as 1 5% from the approved budgets, so that grants that have already been gone over with a fine-tooth comb by the study sections and have been given the minimum required for carrying
subspecialty
trition,
even though challenging
metab-
acquiring
Because
medical-school years
have
by medical
as a discrete
difficulty
are weighing
disciplines, and
had difficulty
agents.
budget
research
tritionists.
journal.
with it responsibilities. We can no longer consider ourselves a fledgling group struggling for survival. We have become a mature society that has taken its place among the clinical-investigation societies
and Digestive in nutrition nutrition.
mem-
its high scientific standards of the academic achievements
for its outstanding
Notes last fall, the statistics for support ofnutrition training are appalling. In 1988, the National Institute
today
has told you that
level of over 1000. I believe that ASCN as the foremost academic clinical-nutrition
the world membership;
American
heard
at a healthy
his membership
and
ofcredit)
decade
(ASCN).
members
Dr Atkinson deal
gators,
and training
Pi-Sunyer
Society the
for nutrition
1990
out
the
research
outlined
are crippled
before
they
begin their research-grant period. Part ofthe problem is that NIH is trying to lengthen the grant period of individual grants, having moved them from an average of 3.3 to 4. 1 years. Although this is a basically sound policy, NIH
expected
appropriations
to keep
rising,
as they
ically. When this did not occur, the extra funding the lengthening ofgrants and also for maintaining
Presidential Address, given at the annual meeting for Clinical Nutrition on May 3, 1990. 2Address reprint requests to FX Pi-Sunyer, Division I
had histor-
required for an adequate
of The American
Society
Diabetes and Nutrition, St Luke’s-Roosevelt Hospital dam Avenue at 114th Street, New York, NY 10025. Received October 8, 1990. Accepted for publication October 10, 1990. for Clinical
Nutrition
of Endocrinology, Center,
Amster-
397
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Federal
Address,
398
PI-SUNYER
Where the issue is particularly grim is in the training-grant area. Although, as I mentioned earlier, nutritional research is now estimated to account for about 4.2% of the NIH budget, nutrition-research training accounts for only 1.7-1.9% of the training activities of NIH. The training program at NIDDK’s Division of Digestive Diseases and Nutrition (DDDN) takes up only 5-6% of DDDN funds. Of 37 institutional training grants (T32s) in DDN, 23 are in digestive disease and only 7 are in nutrition. Most of those in nutrition are predoctoral, and only 7% of the trainees are MDs. The total number of trainees accommodated by these grants is 17 predoctoral and 14 postdoctoral, nationwide. Of individual fellowship grants (F32s) there are only 7 in nutrition and 23 in digestive disease. The number offunded institutional training grants in nutrition have dropped from 12 in 198 1 to 7 in 1990. Individual postdoctoral fellowships have dropped from 17 to 7. Career Research Awards have dropped from 6 to 3. There is only one Program Project Grant in nutrition. The number being trained in nutrition does not begin to replace those leaving the investigative arena for administration, retirement, or other pursuits. Because the cadre was already small, the present numbers are extremely alarming. Soon there will be no role models in our medical institutions for young
species
to emulate.
Nutrition
is definitely
an endangered
that needs nurturing and support. This is particularly of clinical nutrition. NIDDK has become aware ofthe great problem in nutritiontraining funding. It has now moved to special request for applications (RFAs) in nutrition, with nutrition applications being reviewed by a special study section of nutrition peers. The next deadline for these grants is July 1990. On the first round, 1 year ago, very few fellowship applications were received. We will not get more slots if we do not apply and I urge you to do so. I wish to move on to another disturbing element in the funding picture: Clinical Nutrition Research Units (CNRUs). At the moment there are eight CNRUs in the United States and one Obesity Center funded under the same program. Three of these true
ever,
possibly
because
of the greater
clout
or political
pressure
ofthe digestive-disease community and its supporters, or possibly because ofa better ability to write good Center grant applications, the DD Centers have grown more rapidly than the CNRUs. It is clear
in my mind
that
the CNRU
is a wonderful
way to obtain
for clinical
particular.
investigators
are funded by NC! and the rest by NIDDK. On the other hand, there are 12 Digestive Disease (DD) Centers. Some years ago there was an equal number of CNRUs and DD Centers. How-
nutrition a presence in a medical-school setting and ofbridging the basic-science and clinical-science nutrition areas. Where Centers have been instituted (University of Alabama at Birmingham, University ofChicago, Davis, University of Washington,
University Vanderbilt
ofCalifornia University,
at Uni-
versity of Oregon, University of California at Los Angeles, Memorial Hospital for Cancer and Allied Diseases, and our Obesity Center at St Luke’s-Roosevelt of Columbia University), they have brought with them an institutional framework and a research presence that has enhanced not only investigation but recruitment of new young talent and a valuable educational presence. The CNRU route is clearly the way to go to build up a clinical-nutrition presence in schools around the country. Yet we are now frozen at the number presently funded, and to fund a new unit, one of the old ones must be discarded. We cannot compete
with
DD
Centers
for their
slots.
What is the answer to all this? Well, the answer is that the digestive-disease community, the diabetes community, and the cystic fibrosis community were successful in obtaining more centers
and
more
support
because
they
were
vocal
and
they
lobbied Congress and NIH hard for support. ASCN needs to ally itselfwith other societies interest
to our Enteral for the to join educate
We have not. that have a similar in seeing the lot for nutrition improve. We need to talk sister societies, the American Society of Parenteral and Nutrition (ASPEN) and the North American Association Study ofObesity (NAASO) and I think we would do well them in a lobbying effort on Capitol Hill. We need to our Congress that nutrition research is important, that
it is endangered,
General Budget
and
that
it needs
special
support.
Only
if the
Accounting Office and the Office of Management and are instructed directly by Congress to fund nutrition programs will we get NIH (and the US Department of Agriculture, for that matter) to move from its present policy, and only then can we ensure the continued viability of clinical-nutrition research. I urge all of you to help in this effort. It is vitally important to us as investigators, to our potential trainees, and to our society. 0
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amount of funding for new grants was not available. The precipitous drop in funding of ROls is the result. The most disquieting part ofthis is that the individuals most hurt by this are the younger and new investigators, and ifthey are disappointed enough, they may disappear from the scene, never to be recovered. We are therefore putting at risk the continued existence of a viable and creative young generation that would continue to do outstanding science in general and nutrition science in