Scientists Decode Secret of Getting NIH Grants – WSJ

Scientists Decode Secret of Getting NIH Grants – WSJ

Mon, 28 Jun 2004

The Secret of Getting Grants: Marketing Helps University Win $350 Million a Year, by Bernard Wysocki, a front page article in The Wall Street Journal, provides insight into an iron triangle that controls medical research. This triumvirate has tainted not only the grant approval process but the focus and integrity of research, as greed and ambition have won over scientific merit.

The article focuses in particular on the University of Pittsburgh (Pitts), and the aggressive, manipulative marketing tactics employed by a master grant getter, Dr. David Kupfer, head of the department of psychiatry, who has succeeded in obtaining hundreds of millions in grants annually from the National Institutes of Health and untold millions from the pharmaceutical industry.

Inasmuch as psychiatry has made hardly any advances in the treatment of mental illness–which is ostensibly the focus of psychiatric research–Congress should be asking what was done with those funds?

That is not to say, that psychiatry has done nothing with the money. The WSJ reports: “Pitt’s strategy, since the university is building a $205 million biomedical tower scheduled to open in 2005. The tower will have annual operating costs of about $75 million. More than 80% of this is expected to come from NIH grants.”

High profile academic psychiatrists, such as Dr. Kupfer (the center piece in the article), have been enormously successful in garnering both government grants and pharmaceutical company contracts. University-based psychiatrists, whose influence at the National Institute of Mental Health is described in the WSJ article, simultaneously collaborate closely with drug manufacturers. Together they have made psychotropic drugs blockbuster profit earners: in 2003 antidepressant drug sales rose to $19.5 billion and antipsychotic drug sales rose to $12.2 billion.

This marketing feat was accomplished by an iron triangle composed of pharmaceutical company executives, university psychiatrists, and NIMH psychiatrists who worked in unison to promote the newest, most expensive psychotropic drugs–antidepressants of the SSRI class and so-called atypical anti-psychotics–as first line treatment for anyone complaining about almost any dissatisfaction. The drugs are widely and indiscriminately prescribed even though they have failed to demonstrate safety or effectiveness in controlled clinical trials conducted by a cadre of academic / company investigators. The successful marketing of the drugs was accomplished by concealing evidence from failed trials and evidence of severe adverse drug effects–including increased risk of suicidal behavior which, in children is double the risk.

The Wall Street Journal report concludes:

These days, with NIH funding on a plateau after the five-year doubling, Drs. Levine and Kupfer are ratcheting up the pressure on scientists to keep up the frenzy of grant applications. Dr. Kupfer says he wants the number of psychiatry department proposals to double, from 165 last year, to take more of the NIH money in a flat market. “We will increase our market share,” he vows.

Contact: Vera Hassner Sharav
Tel: 212-595-8974

At Pitt, Scientists Decode The Secret of Getting Grants

June 28, 2004; Page A1

PITTSBURGH — For David Kupfer, getting grant money from the National Institutes of Health isn’t only about science. Marketing is also key to success.

So earlier this month, the head of the University of Pittsburgh’s psychiatry department used an NIH-sponsored conference in Phoenix for a bit of self-promotion. Allotted five minutes to speak as co-chairman of a panel on bipolar disorder, he filled the time with a PowerPoint presentation pitching his own ideas on the subject — which are central to a $4 million grant proposal now pending at NIH. In the audience: prominent psychiatrists who sit on the NIH review panel that will help decide whether Pitt gets the money.

The maneuver is one of many that Dr. Kupfer, 63 years old, says he uses to try to score hundreds of millions of dollars for Pitt in grants from Uncle Sam. A consummate schmoozer, he chats up NIH officials about hot new areas that might produce funding for his 240 faculty members and researchers. He requires young Pitt scientists to attend boot camps on grant writing. And he makes sure the scientists who win NIH money get onto the agency’s review committees to further penetrate the grant-giving system at NIH, in Bethesda, Md. Researchers can get bonuses of as much as $50,000 a year based on how much NIH money they bring to Pitt.

“We’re called Bethesda North,” says Dr. Kupfer.

There’s a lot of NIH money to be had. In the past five years, the budget of NIH has doubled, to $28 billion. Some of that money goes to researchers in Bethesda who are directly employed by NIH’s 27 institutes, such as the National Cancer Institute. But the lion’s share — about 80% — gets parceled out to other researchers across the U.S.

NIH isn’t the only government agency whose largess is eagerly sought by universities. In Atlanta, Emory University has used its proximity to the federal Centers for Disease Control to win contracts for CDC-related research. The University of Pennsylvania has created an Institute of Strategic Threat Analysis and Response, a loose alliance of experts from 12 Penn graduate schools, to go after big federal grants from the Department of Homeland Security and other sources of funds.

Few institutions, though, have made such a grab for market share in government funding as the University of Pittsburgh and its affiliated 20-hospital medical center.

A research also-ran 20 years ago, Pitt has successfully gone after NIH funds in psychiatry, cancer research, genetics, and other fields. The university has funneled revenue from its organ-transplant program, a world leader since the 1980s, into recruiting new faculty and expanding its research. Last year, thanks in part to the newcomers, Pitt pulled in $350 million of NIH money. That made it the eighth-biggest recipient, up from No. 12 just five years ago and ahead of such eminent research universities as Yale, Duke and Columbia.

In a cheeky symbol of its emergence into the top tier, Pitt last September recruited away the entire 20-person biosecurity think tank from Johns Hopkins University, the No. 1 recipient of NIH funds. Pitt pledged to spend $12 million getting the team established at spiffy offices in downtown Baltimore. It hopes the biosecurity researchers will get government money, especially homeland-security funds, not only for themselves but also for colleagues in Pittsburgh.

“As long as the federal government is the major funder in the billions of dollars, we want our colleagues to be in the Baltimore-Washington area … [and] quite frankly to be first in line to bring the funds back to Pittsburgh,” said Jeffrey Romoff, president of the University of Pittsburgh Medical Center and architect of the deal, speaking at a press conference. In return for all this money, of course, the American public is supposed to get progress in combating disease. The university’s cutting-edge research includes an effort to reverse the effects of stroke by surgically implanting nerve cells. It has also developed a substance called Pittsburgh compound B that enhances images taken of the brains of Alzheimer’s-disease patients.

Still, research universities and NIH itself are under pressure from Congress to show even greater results. Some legislators want NIH to devote itself less to fundamental scientific inquiry and more to “translational” research that can generate drugs, devices and other therapies. Among scientists, there is fierce debate about how to make research more productive. Some think NIH allows too much bottom-up research proposed by individual scientists; others say it creates too many top-down megaprojects with grand but elusive goals.

Pitt plays both sides of the game, with big teams and individual efforts, and its success is the envy of other universities. “We’re consciously headed in the same direction,” says Fred Sanfilippo, senior vice president of health sciences at Ohio State University, which is building a $150 million biomedical tower.

The battle for grants is expected to become more bare-knuckled because the NIH is no longer getting double-digit budget increases each year — a result of the federal budget deficit and feelings in Congress that the institutes now receive enough money.

Already, there is resentment against Pitt, say some scientists. Thomas Insel, director of the National Institute of Mental Health, says people from competitor universities who sit on review panels sometimes say, “God, those people already have so much going on; we need to spread the wealth.” Michael Swift, a genetics specialist formerly at the University of North Carolina and New York Medical College, is a critic of Pitt. “They’re teaching people how to work the system,” he says. “What does it have to do with science or health? It has a lot to do with money.” Dr. Swift, 69, won more than $10 million in NIH grants during his career but has had trouble getting NIH funding in recent years. He is now retired from academia and does research independently.

By far the biggest winner in getting NIH money — and the template for the rest of Pitt — is the university’s psychiatry department and its affiliated 276-bed Western Psychiatric Institute and Clinic, which last year pulled in nearly $75 million in funds from NIH, mostly from the National Institute of Mental Health.

Dr. Kupfer, a trim New York native, operates from the institute’s Depression-era brick tower with a salesman’s optimism. He frequently calls branch chiefs at NIH’s various institutes and keeps in constant touch with Pitt researchers who leave to take positions there, inviting them back for lectures. Of one colleague who left for NIH, he says fondly, “He left but he never really left.”

Within NIH’s mental-health institute, Pitt has long occupied a spot on the 18-person national advisory council, which makes funding recommendations to the director after an initial review by scientific committees made up of experts in specific subfields. People now speak of the “Pittsburgh seat” on the advisory council. Other universities have representatives on the council, but nobody talks of a “Yale seat” or a “Cornell seat.”

The current occupant of the Pittsburgh seat is Charles Reynolds, a senior Pitt faculty member. “It’s extremely self-serving,” says Dr. Reynolds of his position on the advisory council. He has used his seat, he says, to lobby successfully to reinstate a branch of the mental-health institute devoted to his specialty, the mental health of the elderly, although he plays no role in approving his own grant proposals.

To make sure Pittsburgh stays ahead of the pack, Dr. Kupfer runs an intensive “survival skills” course for young postdoctoral fellows in psychiatry to train them in the fine points of applying for their first grants, typically about $600,000 for five years. The biggest trick young scientists need to learn, he says, is to focus their proposals more narrowly. To Dr. Kupfer, it’s almost like marketing or branding. “You need a T-shirt,” he constantly exhorts his charges, by which he means a quick phrase that tells the world what the research stands for.

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These days, with NIH funding on a plateau after the five-year doubling, Drs. Levine and Kupfer are ratcheting up the pressure on scientists to keep up the frenzy of grant applications. Dr. Kupfer says he wants the number of psychiatry department proposals to double, from 165 last year, to take more of the NIH money in a flat market. “We will increase our market share,” he vows.

As added incentive, Dr. Kupfer runs a bonus program that allows scientists to get a payment equal to 10% of the size of a grant, up to $50,000 a year. The program, once limited to the psychiatry program, has been expanded by Dr. Levine to all of Pitt’s health sciences departments.

Dr. Kupfer also thinks psychiatry can tap sources of funding beyond NIH’s mental-health institute by teaming up with scientists in other fields. A few weeks ago, he spent an hour brainstorming with Tara O’Toole, the head of the biosecurity team that Pitt lured from Johns Hopkins, on ways to join forces. One idea: trying to get grant money, from the NIH or elsewhere, to study how to avoid mass public hysteria in the event of a terrorist attack.

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