Stakeholders
Many groups are highly invested in NIH funding. Two key stakeholders will be addressed in the following portion of this paper; namely the general public and extramural researchers. Extramural researchers are directly impacted by NIH funding and the general public is providing the funds and should be receiving the benefits.
General Public: One of the goals of the NIH is to “expand the base in medical and associated sciences in order to ensure a continued high return on the public investment in research.” Taxpayer dollars funding NIH are from the taxpayers, making them the primary beneficiaries of advances in research. Thus, the general public is a key stakeholder in the decisions resulting from the NIH funding policy. Congress theoretically represents the public interest as the NIH Advisory Committee allocates to the NIH, and the funds to the Director. However, many in the general public do not feel their interests are being accurately represented. As a result, individuals have formed patient advocacy groups to represent their own interests. Patient advocacy groups tend to focus on specific aspects of health care or diseases. Advocates get involved in many different areas such as organizing awareness campaigns, promoting patients’ rights, and enhancing health policy initiatives. Most importantly, patient advocacy groups are oftentimes involved with advisory panels to ensure that current projects and those projects being considered for funding will directly impact patients’ lives, improve delivery of care, and provide support for tertiary care. Advocacy groups strive to promote a health care system that is beneficial for all parties involved. Through congressional representation, NIH Advisory Committee efforts, and patient advocacy groups, the public is able to influence funding allocation as well as the policy itself.
Extramural Researchers and Scientists: Other important stakeholders of the NIH funding policy are the researchers and scientists themselves. Extramural researchers differ from intramural researchers in that they are not employed by the NIH but must apply for funding. Throughout the history of the NIH, the amount of funding received has increased, but the proportion to each IC remains relatively constant. The individual ICs then decide who will receive the grant money and how much will be allotted. Research funding is important to extramural researchers for multiple reasons. Without the help of an NIH grant (or a similar type of funding), researchers and scientists are unable to pursue their own research interests but are obliged to follow the agenda of the company or university for which they work. This could potentially hinder discoveries in novel research areas. In 2000, Brian Jacobs and Lars Lefgren researched extensively the impact of NIH grants on basic research and development, and the careers of grant recipients. For the period of 1980–2000, they reviewed all postdoctoral research grants and standard research grants for those who received funding and those who did not. Jacobs and Lefgren found that scientists who received postdoctoral research grants were 20 percent more likely to be published within the first five years after receiving the grant. They also found that scientists who received grants were 11 percent more likely to have one publication and 23 percent more likely to have five publications. Due to the ‘publish or perish’ standard that many researchers face, NIH funding can have a great impact on researchers’ careers. Receiving a standard research grant also has a significant impact on researchers. Young scientists who receive a first-time grant (R01) usually produce more than one additional publication in the five-year period after they receive the grant. Those who receive an NIH grant will typically receive $252,000 more in NIH funding in the following six to ten years, and a statistically significant relationship exists between scientists receiving NIH grants and their research productivity throughout their careers. Policy changes on who receives funding also significantly affect researchers. For example, the NIH has recently attempted to approve more first-time NIH R01 applicants, or the research grant applications of young scientists. To encourage the participation of young scientists who potentially think outside the box, the application process has been shortened and made easier. In addition, first-time applicants are being offered more funding for their research grants than those who have received grants in the past. Although this change provides greater opportunities for young scientists, it also places older, more experienced scientists at a funding disadvantage.
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