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search in the United States, was $140 million, slightly less than 1 percent of the $14.8 billion NIH research budget. It is important to understand, however, that these numbers provide only rough approximations, because the lines distinguishing health services research from traditional clinical research are often indistinct. Nonetheless, it is reasonable to conclude that proportionately more health services research is supported through private foundations than by federal agencies.
There are not many applicants. A 1999 request for proposals (RFPs) on quality indicators for health care in MS and another RFP on access to health care for MS among rural populations care generated only 2 applications each. Only two applications were submitted for dissertation fellowships. It would be useful to determine whether this is because the pool of applicants is so small or because qualified applicants are either unaware of or uninterested in the opportunities.
ROLE OF VOLUNTARY HEALTH ORGANIZATIONS
The role of philanthropic funding in strengthening health research is vital in that it carries the unique capacity to invest in innovative and creative risk-taking projects.
Enriqueta Bond, president
Burroughs Wellcome Fund
Gaps and opportunities that currently exist that could be filled by foundations include training physicians and Ph.D. researchers to adapt to changing needs; support for emerging field and interdisciplinary research; support for risky research; speeding research from bench to bedside; behavioral research; public understanding of science and communication; and new partnerships.4
“The federal research grant administration process, encompassing the peer review process, has become cumbersome, inefficient, and an impediment to scientific excellence. Investigators spend as much as 30 percent of their time preparing lengthy grant applications, responding to regulations, and preparing administrative documentation. Although some time and expense are necessary, the current system siphons excessive dollars and time into efforts that do nothing to promote progress against cancer.”15
(Note that this quote was not intended as a criticism of peer review, which the report noted was a great strength of the federal research grant administration process.)
Unlike federal agencies, private research foundations are not encumbered by the obligations of a public agency, which allows them considerably more freedom to adopt flexible policies. They can also to some degree piggyback onto policies established by the federal government—for example, policies for the appropriate care and use of animals in research, trainee programs for the ethical conduct of research, and intellectual property agreements. Private foundations can more readily develop expedited grant review, and select individual investig-