Strengthening Research in Academic OB/GYN Departments (1992) / Chapter Skim
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4 NIH POLICIES AND STRUCTURE
4 NIH POLICIES AND STRUCTURE
Pages 109-124
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From page 109... ...
Furthermore, several major arms of OBIGYN interest, including few research, cannot currently receive fedem1 funding. In adldidon, it is ~d, OB/GYN as a clinical discipline suffers the saw diffic';ilties in gamenng MH Ends It are experienced by all clinical mv~igatom, including review by study sechons on which basic scientists outnumber clinical scientists.
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From page 110... ...
Some current "d four NIT repre sentatives, however, dispute the notion that this is the case for OB/GYN. They point to an attendant in the early 1970s to English OB/GYN in the intramural program as an Indication ^~t NIH supports He idea of OB/GYN intramural resmrch.~ bisons research ~ reproducti~rc cndocnnolog~y is conducted ~ the NIH intramural program, sad a lime OB/GYN-rclatcd laboratory mscarch ~ conducted by Asia fcDows Tom ores.
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From page 111... ...
16 order ~ provide for both Aces and research needs ~ this area the Committee directs He National Artistes of Heals to establish a cIinica1 research program ~ gynecology "d obstetrics within He National Institute of C hild Heals and Human Development.S OBJGY}I cli~ic~ns because of the different ~ pay bet~ccD the MH "d pate practice (-cd on pemosa1 commmnca~ons~om Sac F Alc~dcr' Diner, Natiom1 ~c of Child Health Ed Hum" Dcvelopm~, NatioDal I - tutcs of Health, and RoDald A
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From page 112... ...
The Committee requests Hat NICE) develop a plan to animate ~ intramural research effort to conduct research on pregnancy and perinatology....7 The National Institute of Child Health and Human Development (NICHE)
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From page 113... ...
Wiener these activities will grow beyond the symbolic to the meaningfi~1 that is, to He point where the NIH intramural program becomes a significant force in OBtGYN training and research~not today be prophesied. But even if the intramural OB/GYN effort remains relatively small, some of He disadvantages of operating in the absence of an intramum1 program Would be diminished: there will be at led a few Mural OB/GYN mves~gators with whom the e~chamutal staff can confer; limited training opporbunides will become available; and the status of OB/GYN investigation will be upgraded.
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From page 114... ...
(See Chapter 5 for furler disclL~ion of 1eade'~p issues.) OB/GYN leaders should also work with Nib staff to identify key issues and otherwise encourage OB/GYN ~ The success of a small group of OB/GYN leaders in persuading NCI leadership to larch intramural activities demos the importance and effe~:dveness bold of leadership lenitive and of wowing closely with NIH staff.
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From page 115... ...
The new instate did have a sabstandal impact in qualitative tams: by expanding the intramural program and developing workshops and programs emphasizing interdisciplinary research, He scope of vision research was considerably expanded. By contrast, when He National late on A-g split off from NICHD, fimding for the new inshtute grew faster than He remainder of NIH for several years.~° 1h short, splitting off a research field fimm an existing institute to form a new insure is no guarantee Cat additional Aids will accrue to He field ~ the long non.
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From page 116... ...
The same low pnont''r for OBIGYN research is reflected In the composition of He councils and committees that advise die directors of NICHD and its centers on program plug demos: · The National Advisory Child Health Ed Human Development Council identifies promising areas of research and defines program prionhes, Primarily by awarding e~ctramum1 grants and contracts in arms deemed to be of high pnonty.~3 The council also reviews the long-term plans of each of the NICE caters. It ~ chair by He director of NICHD (a pediatrician)
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From page 117... ...
RECOMMENDATIONS: Stiles at Ned whose moons include arms of science to whim OB/GYN oontribu~s should affirm Heir commitment to reproductive health and ensue in appropriate priority ~ their programs. The committee believes that there is an Dent new for change that emphasize the importance of OB/GYN resmrclL Actions that would help overcome some of the problems OB/GYN research now oonfron~ might include the National ~tute of Child Heals and Human Development changing its name to signal to the public and institute staff its commitment to and responsibUi~ for reproductive health NICHED could also recognize the importance of programs in reproductive health by establishing the position of deputy director for reproductive bolts or by appointing a barked OBIGYN to the position of deputy Minor.
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From page 118... ...
SWdy ~om like many investigators who sew N1H ~ding, clinical investigators in detents of OB/GYN believe that Be playing held is tilted against conical research. Ibey clarion that Be membership of Be study sections Mat review their grants is overwhelmingly composed of basic scientists who not only Ail to appreciate Be scientific worth of clini=1 studies but also Nil to uDde~and clinical investigation is necessarily less ngorous Off bench science: the clinical investigator Knot control all Be characteristics of Be study population; ethical constraints, such ~ patients not receiving s~of-the-art At, malce it difficult to select appropriate controls; confounding variables are difficult to eliminate; and the costs of clinical investigation tend to be high in comparison win the costs of basic science.
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From page 119... ...
An unpublished study of clinical research applications sent to six Ned review groups between 1977 and 1980 showed Mat approval rates and priority scores were not affected by the percentage of M.D.s Hong remew~s.38 Nevertheless, Many clinical m~restigators believe Hat NIH Judy sections as presen~dy cogitated are not appropnate for He evaluation of clinical investigation. Over the years they have called for separate review of basic and clinical investigations, by study swoons composed of experts in such wow.
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From page 120... ...
The relatively low success rate of applications for grants from d~arunents of OB/GYN (noted in (-ter 2) could be due to the poor quality of the Work berg proposed, a lack of understanding on behalf of the study section members, or some other reason.
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From page 121... ...
members of Me study section. On one point them was agreement among chosen mte~riewed: that We gravity of applications from departments of OBIGYN is at least partly responsible for their low success rate, even taking into account the multiple problems that are inherit in OBIGYN clinical investigation (e.g., tibe limit On invasive procedures Act c" be done on healthy, pregnant populations)
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From page 122... ...
It therefore questioned whether a policy Cat ~ effect prohibits federal fimding of research in an area of growing clinical importance deters would-be investigators, and whether advances ~ the health of patients are adversely affected. Id 1989, an Institute of Medicine committee developed a large clinical and basic research agenda th~t would Fiber the practice of in vitro fer~i=hon.
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From page 123... ...
Lcgida~c liaison Officer, Nesional limits of Child Health and He Dc~rclapmcm, personal ~o~cadon, July 1991.
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