Jennifer Grandis, MD, is something of a unicorn.
Explore This IssueMarch 2020
Currently the Robert K. Werbe Distinguished Professor in Head and Neck Cancer at the University of California, San Francisco, Dr. Grandis received NIH funding the first time she applied. “That was, and is, an unusual experience,” she said.
Her initial grant paved the way to a career filled with discovery. Dr. Grandis has received millions of dollars from the NIH to study the biology of head and neck cancer. Her work is pointing the way toward novel treatments that may change clinical practice and patient outcomes.
“It’s such a privilege to get paid to think, to mentor, and to contribute to discovery,” Dr. Grandis said. “But there isn’t a huge cohort of people anxious to follow in my footsteps. And it’s not because what I do isn’t important but because it’s hard.”
The path to NIH funding is full of twists, turns, and obstacles. It is extremely rare to be awarded an NIH grant on your first try; most investigators submit five to 10 applications before one is funded, said Benjamin Bleier, MD, director of otolaryngology translational research at Massachusetts Eye and Ear in Boston.
Dr. Grandis encourages physician scientists to push through their discomfort and fear of rejection. “The reason most surgeons, including otolaryngologists, don’t get grants is that they don’t apply for them,” she said.
This advice from top clinician-scientists can help pave the way to NIH funding.
NIH grants are extremely competitive, so you’re more likely to find success if you pursue other organizations first. Importantly, securing smaller grants may give you the funding you need to conduct preliminary research and gather the data you’ll need to ultimately convince the NIH to support your work.
“The NIH wants to see data along with your research, so you have to figure out how to get money and data before you can actually write an R01 grant,” said Bert W. O’Malley Jr., MD, the Gabriel Tucker Professor and Chair of Otorhinolaryngology–Head and Neck Surgery at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia.
Dr. Bleier obtained his first grant from the American Rhinologic Society. That grant allowed him to explore the use of laser tissue welding to repair spinal fluid leaks. Later, grants from the American Academy of Otolaryngology and the Michael J. Fox Foundation for Parkinson’s Research supported his work. (At that point, Dr. Bleier had partnered with a neuroscientist to study how the mucosa used in laser tissue welding might be used to deliver drugs directly to the brain, bypassing the blood-brain barrier.)
“I was able to get a significant amount of money,” Dr. Bleier said. “The bar for the foundational grant was a bit lower because the grants didn’t have to go through a formal study section process. The foundation had money they were willing to spend, and [they were] interested in identifying novel research opportunities.”
Dr. Bleier then used the data he obtained from Michael J. Fox Foundation-funded research to support his NIH R01 application.
(The Triological Society also awards grants. See “Triological Society Grant Programs,” p. 25, for more information.)
Collaboration Is Key
“I thought I would blaze my own trail,” said Noam Cohen, MD, PhD, Ralph Butler Endowed Professor for Medical Research at the University of Pennsylvania in Philadelphia. “Ultimately, I ended up getting NIH funding, but it took 10 years.”
Although he did reach out to a few potential mentors early in his career, Dr. Cohen was “a little concerned” that a more established researcher might push him to support the researcher’s interests, rather than supporting his interests and goals.
You have to propose to study something that’s significant, and you have to persuade the reviewers that this is a significant problem. —Jennifer Grandis, MD
Caution is warranted. Maie St. John, MD, PhD, chair of the department of head and neck surgery at the University of California in Los Angeles, ended up having to give back her first NIH grant, a Career Development (K) Award, after one of her mentors told her to focus on breast and pancreatic cancer (his areas of interest) rather than head and neck cancer.
“I remember he said, ‘Breast cancer and pancreatic cancer are like a 747 in the sky, and head and neck cancer is like an old beat-up 1967 Honda Civic,’” Dr. St. John said. “I told him, ‘I’m driving that Honda.’”
The key to success is to find mentors and collaborators who may offer expertise or even supplies or lab space.
“Find a mentor who actually cares about what you’re doing and is interested in your career, not their career,” Dr. Cohen said. Consider reaching across disciplinary borders. Dr. Cohen eventually found collaborators in pulmonary medicine, genetics, and immunology.
Dr. Grandis also reached outside the field of otolaryngology.
“The scientific expertise for me to do what I wanted to do was not present in the department of otolaryngology. We did not have any cancer biologists in the department, so I needed to look elsewhere,” she said.
Learn Grant Writing
Grant writing differs—significantly—from academic writing.
“In a grant, you’re trying to sell the reviewer on your project and how impactful and important it is. In a research paper, you’re very reserved with your results and need to express scientific skepticism,” said Dr. Bleier, who also serves as the chair of the research and grant committee of the American Rhinologic Society. “Writing a grant is really a unique and idiosyncratic exercise.”
Dr. Bleier recommends that would-be investigators reach out to experienced grant writers for assistance. “It’s virtually impossible for someone who’s never done it before to write a reasonable and appropriate-looking grant out of thin air,” he said. “It really is an art form that requires input from others.”
Many academic institutions have grant administration programs to guide students and faculty through the grant-writing process. Some even include grant pre-review programs, in which a panel of experts will review and comment on your application so you can refine it prior to submission.
A mentor who has successfully secured funding can also help you understand the intricacies of grant writing.
Give yourself time to learn. “Expect the first few times you write a grant to take three times longer than any subsequent grant,” Dr. Bleier said. Build in time for peer review and revisions.
Emphasize Innovation and Impact
NIH grants are awarded to investigators who are doing innovative, impactful work. “You have to propose to study something that’s significant, and you have to persuade the reviewers that this is a significant problem,” Dr. Grandis said. Although earwax is a common problem, “it’s hard to convince a reviewer that it’s a significant public health problem,” she said.
And explanations are key. “Grant applicants tend to assume that the reviewers are all experts in the area they’re writing in, and that’s not the case,” Dr. O’Malley said. The reviewers may understand head and neck cancer, for instance, but have little understanding of gene therapy and its possible relevance to head and neck cancer. Or they may know a lot about genomics but little about current head and neck cancer treatments.
The NIH wants to see data along with your research, so you have to figure out how to get money and data before you can actually write an R01 grant. —Bert W. O’Malley Jr., MD
“The more direct and simplified your grant, the better,” Dr. O’Malley said. Emphasize the potential clinical impact.
You can increase your chances of obtaining funding by positioning yourself as the best possible person to study your proposed research question. “Early on, people challenged me because I was a clinician. Why was I the best person to study cancer biology? I’ve always had to make sure that I ask questions that uniquely tap into my capacity to connect to the patient or translate my findings back to the clinic,” Dr. Grandis said.
Most of her grant applications to date have included the study of biospecimens. “Access to high quality patient tissues is not trivial, and a basic scientist can’t necessarily obtain these specimens,” Dr. Grandis said. As a surgeon, however, she has the opportunity to develop and steward a tissue bank, and use those tissue samples to advance the understanding of head and neck cancer.
Target the Right Study Section
The NIH is composed of 27 institutes and centers, or ICs. Grants are awarded through ICs, so researchers interested in obtaining funding would do well to identify ICs related to their work. You’ll also want to learn more about the composition of the study section that may be reviewing your grant.
“Picking where to send your grant is a bit of an art, because you can request that it goes to a particular study section,” Dr. Bleier said. To identify the best study section for your research, work with a NIH program officer. The program officer can discuss your grant with you and help you target an appropriate study section.
“If you don’t have anybody in your study section who understands ENT or your clinical problem, you’re going to have a much harder time getting funding,” Dr. Bleier said. That said, there aren’t many reviewers who specialize in rhinosinusitis, for instance; study sections that review sinusitis-related proposals may include immunologists instead.
Spend some time learning who is part of the study section. “The goal is not to call them and ask them to lobby for you; it’s to understand their expertise,” Dr. O’Malley said. “If you understand their expertise, you can better write and explain yourself to that audience.”
Use Feedback to Strengthen Your Grant Application
Don’t give up if your grant application isn’t funded. “I’ve learned a lot from grants I haven’t gotten,” Dr. Grandis said. “When you don’t get a grant, you get constructive feedback that allows you to refine your proposal and send it somewhere else.”
If initial feedback indicates that your research plan is solid, but the reviewers aren’t sure if the research question is significant enough to warrant funding, think about, “How can I adapt my question so it has a higher impact?” Dr. Bleier said. Or, if the reviewers don’t think that your data is strong enough to demonstrate feasibility, conduct additional research to prove that your proposed study “isn’t just feasible in general, but feasible in your lab,” he said.
Use your passion to fuel your repeated efforts. “You have to really care,” Dr. Grandis said. “You’re going to get more pushback and rejections than you are going to get accolades and rewards, so you really have to think your work matters.”
Jennifer Fink is a freelance medical writer based in Wisconsin.