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

Federal funding for nutrition research and training.

Presidential funding F Xavier This is the first year of the fourth for Clinical that the society number which great research Nutrition is doin...
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