WASHINGTON -- In an opening plenary session at this year's conference of the Heart Failure Society of America (St. Paul, Minnesota), Gale Pearson, of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, laid out what she called a "roadmap" and a "blueprint" developed by the NHLBI to provide "global leadership" and a "strategic planning process" as an "optimal heart failure research catalyst."

It sounded good. It sounded wonderful.

But for another presenter at the conference, neither this roadmap, nor the NIH in general is providing the support needed for groundbreaking types of research in the biomedical arena.

The strategy Pearson described is multi-faceted and multi-focused. She said that the development of the roadmap began with a series of questions concerning the barriers and hurdles and how to overcome them to improve NHLBI operations; the identification of goals that will guide the exploration of the molecular and physiological basis of heart failure; an exploration of the clinical mechanisms of the disease; and methods for carrying out research on the disease and changing patient behaviors.

She reported that the NHLBI has developed a variety of working groups to drill down into these questions, come up with answers and share their findings, all with the purpose of "declaring war on heart failure."

The presentation was detailed, complete in the elaboration of study methods, approaches and the outlining of trials to potentially answer some of these questions, and Peterson's enthusiasm couldn't be questioned.

But in a presentation immediately following Peterson's, Andrew Marks, MD, of Columbia University (New York), did question it. He charged that the NHLBI roadmap, while a strong ideal, isn't likely to work because the NIH is not providing the required support to investigators pursuing important research and that the institute essentially is in crisis.

Marks said that only one of every 11 grant applications is being funded and that a great deal of time is wasted in the process of revising and resubmitting grants, a process that frequently produces a two-year delay in the launch of important investigational studies.

In particular, Marks said that the system is pitting women scientists and junior scientists vs. "majority scientists" and creating a variety of frustrations.

The results include "colleague despair," "career revaluation" and the breaking up of research teams as these non-majority researchers leave the field and thus fail to pursue promising research opportunities.

"It's much, much harder to get a grant," Marks said, describing the funding ups and down at the NIH as a "roller coaster," the difficulty of the grant-winning process as "the NIH treadmill" and grant-funding decisions as "ultra-conservative," because NIH is only making awards to research that seems "certain of success."

The result is the rejection of "creative" and "risky" research projects, he said, that could lead to important discoveries and that the NIH is "rejecting grants from really good scientists."

Besides pinpointing problems in the NIH grant system, Marks sketched other funding issues working against biomedical research.

He noted that while the U.S. government spends more than $1,000 per person in military spending, it contributes a bit less than $100 per person for biomedical research.

Marks acknowledged that NIH funding has generally doubled recently, but warned that this produces unrealistic expectations because "you will not get two times the productivity." Rather than seeing quick research results, he said instead that "the payoff has to be long-term."

Not just offering criticisms, Marks provided a variety of needs and recommendations.

He said that the U.S. Congress needs to "champion" the cause of biomedical research with more funding based on the simple hypothesis that "healthy people are a whole lot more productive than sick ones." And this support, he said, should include partnerships "with the private sector" and the "clinical studies industry."

He emphasized the need to streamline the NIH research granting process by using, for instance, shorter application forms and faster processing protocols.

And he pushed the need for a different attitude toward clinical research at the institute, saying that currently it is in "Rodney Dangerfield" mode because getting "no respect."

"NIH funding goes to basic rather than clinical research," and, as a result, some of the most important clinical research in the field is going to India and China.

Finally, Marks said that the NIH should be forced "to publish the amount of money going to different areas of research."

-- DON LONG