Published 11/1/2007

To grant or not to grant … that is the question

A conversation with NIAMS Director Stephen I. Katz, MD, PhD

To get an “insider’s perspective” of the grant-making process of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), AAOS Now’s senior science writer Annie Hayashi spoke with the agency’s director, Stephen I. Katz, MD, PhD. NIAMS strives to “support scientific excellence” by awarding grants to orthopaedic clinician scientists.

Ms. Hayashi: Would you explain how NIAMS determines its funding priorities?

Dr. Katz: We have a tremendous number of inputs when we make our funding priorities. We get input from the scientific, professional, and lay communities in workshops, roundtable discussions, and meetings—identifying scientific opportunities as well as gaps in research. We also have a more formal planning process where we invite representatives from various parts of our mission areas to talk to us about specific areas.

Our professional staff members have expertise in particular topics to assist in identifying scientific priorities and the gaps they see in research. Our Advisory Council also provides input. The public also has a role in giving us information about their needs. The Executive branch and the Congress also have many inputs.

The way we determine our priorities is not by simply “marrying” these needs, priorities, and inputs with the outstanding applications submitted by the various communities that we serve. Our goal is to support scientific excellence. There is no particular “earmark” for one or another area of science. We are supporting outstanding science across the areas of bone, joints, muscle, and skin. That is how we make the determination.

More than 65 percent of NIAMS-supported research is initiated by investigators. It is what clinicians and researchers are telling us is important, doable, and worthy of support.

Ms. Hayashi: How do you gather all that information into a useable form to determine your priorities?

Dr. Katz: We do that through discussions—lots of vigorous and thoughtful discussions—and many iterations of possibilities. Then the decision has to be made about the direction we are going to take. It doesn’t mean that if we don’t do something one year, we won’t do it the next year.

We have over a half a billion dollars to spend, but is it enough money to actually support all the outstanding research that can be done? No, and that is the reason tension can develop. But each of the communities knows that they have people sitting in advisory positions representing their interests, making decisions, and knowing those decisions are fair.

The most important part of my job is to be fair. It is also important for me to steward the Federal funds in a responsible manner. I also attempt to foster collegiality, interaction, and utilization of existing resources wherever I can. That is how I perceive my role.

Ms. Hayashi: Since 2003, adjusting for inflation, the National Institutes of Health (NIH) budget has not increased at all. The administration’s proposed budget for fiscal 2008 would cut NIH funding by $250 million, and the proposed House budget includes a small increase. With these budgetary conditions, how can you continue to support the research needed to address the nation’s health questions?

Dr. Katz: When the NIH budget was doubled, we were asked to do new research, new trials—even though we were not funding all of the outstanding research, as defined by our “peer-review” process that was being submitted. In the late 1990s and early 2000s, we had enough money to launch some clinical studies that were expensive but very important.

We started investing in larger scale clinical trials and studies, such as the Spine Patients Outcomes Research Trials (SPORT) with James N. Weinstein, DO, MS, as the principal investigator. Even when the budget was flattened, the SPORT study remained a priority and we continued to support other outstanding clinical studies. We funded a scoliosis study with Stuart L. Weinstein, MD, as the principal investigator, as well as a study on reaming broken bone conducted by Marc F. Swiontkowski, MD.

Ms. Hayashi: What is the role of the NIAMS in funding orthopaedic research?

Dr. Katz: We have a multipronged approach to our research support, encompassing support for new and young investigators. Without a commitment to training the investigators for the future, we will have no future.

The remainder of our approach is to gain an understanding of the most fundamental aspects of bones, muscles, tendons, and ligaments. Before one even begins to think about a bone cell, one has to think about a cell in general. How do cells interact? That’s why we are involved in and fund basic science studies.

We also look at animal models. We are committed to generating animal models of disease as well as health, such as exercise models and the role of exercise in muscle and bone.

We invest in translational studies—knowledge in the laboratory acquired at the “bench” that can be translated to a human being. That is a long, difficult process—progressing from the laboratory bench to the animal model, then to the human being.

In the area of orthopaedics, we do studies that no company would ever do. The scoliosis study, the SPORT study, and the fracture study would never be supported by a company because they don’t involve instrumentation. There were no financial benefits to be realized from those studies. When we do studies involving a product, we choose them very carefully.

NIAMS also has supported some important orthopaedic outcome studies such as on the effects of early vs. delayed rehabilitation for total hip replacement (THR). The benefits of early rehabilitation following THR have been documented by studies we funded. We are pleased to support these types of studies because they have a positive impact on public health.

Ms. Hayashi: What misconceptions do orthopaedic surgeons and research scientists have about NIH/NIAMS funding?

Dr. Katz: There is the misconception that funding is “impossible” to get. It is not impossible to get funding. Good research is going to be funded. Moving the fields of musculoskeletal medicine and research forward is our goal. Musculoskeletal medicine encompasses all of the issues that we discussed and is a priority. Training physicians and PhD scientists in musculoskeletal research is also an important priority.

Ms. Hayashi: What else would you like our readers to know?

Dr. Katz: One thing that should be added is the partnerships we have and are open to having with others. Our partnership with the Orthopaedic Research and Education Foundation is an important one for NIAMS. We can and will expand partnerships with professional, lay, or academic organizations that have common goals with us. As long as we do things according to NIH rules, we can form these crucial partnerships.

I enjoy working with the orthopaedic community. They have embraced me and helped me enormously. We have wonderful people on our Board and I truly appreciate their time and the tremendous talent of the orthopaedic community.

Annie Hayashi is senior science writer for AAOS Now. She can be reached at hayashi@aaos.org