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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs STRATEGIES TO LEVERAGE RESEARCH FUNDING Guiding DOD’s Peer Reviewed Medical Research Programs Committee on Alternative Funding Strategies for DOD’s Peer Reviewed Medical Research Programs Medical Follow-Up Agency and Board on Health Sciences Policy Michael McGeary and Kathi E. Hanna, Editors INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. W81XWH-04-C-0077 between the National Academy of Sciences and the U.S. Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Strategies to leverage research funding : guiding DOD's peer reviewed medical research programs / Committee on Alternative Funding Strategies for DOD's Peer Reviewed Medical Research Programs, Medical Follow-Up Agency and Board on Health Sciences Policy ; Michael McGeary and Kathi E. Hanna, editors. p. ; cm. Includes bibliographical references. ISBN 0-309-09277-9 (pbk.) 1. Medicine—Research—United States—Finance. 2. United States. Dept. of Defense. [DNLM: 1. United States. Dept. of Defense. 2. Biomedical Research—economics—United States. 3. Research Support—methods—United States. W 20.5 S8986 2004] I. McGeary, Michael G. H. II. Hanna, Kathi E. III. Committee on Alternative Funding Strategies for DOD's Peer Reviewed Medical Research Programs. R854.U5S754 2004 362.1072073—dc22 2004022342 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2004 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Adviser to the Nation to Improve Health
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs COMMITTEE ON ALTERNATIVE FUNDING STRATGIES FOR DOD’S PEER REVIEWED MEDICAL RESEARCH PROGRAMS Joseph S. Pagano, Chair, Lineberger Professor of Cancer Research and Director Emeritus, Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine Samuel Broder, Executive Vice President, Celera Genomics, Rockville, Maryland (member until May 25, 2004) Eric G. Campbell, Assistant Professor, Institute for Health Policy, Department of Medicine, Massachusetts General Hospital, Harvard Medical School Thomas C. Caskey, President and Chief Executive Officer, Cogene Biotech Ventures, Ltd., Houston, Texas Robert Cook-Deegan, Director, Center for Genome Ethics, Law, and Policy, Institute for Genome Sciences and Policy, Duke University Maryann Feldman, Chair, Technical Innovation and Entrepreneurship and Professor of Business Economics, Rotman School of Management, University of Toronto MaryAnn Guerra, Vice President, Research Operations, Translational Genomics Research Institute, Phoenix, Arizona Musa Mayer, Consumer and Author, New York Frank E. Samuel, Jr., Science and Technology Advisor to Governor of Ohio Project Staff Michael McGeary, Study Director, Medical Follow-Up Agency Reine Y. Homawoo, Senior Program Assistant, Medical Follow-Up Agency David Butler, Senior Program Officer, Board on Health Promotion and Disease Prevention (July 2004) Jennifer Pinkerman, Research Associate, Medical Follow-Up Agency (through May 2004) Susan McCutchen, Research Associate, Division of Behavioral and Social Sciences and Education (June 2004) Kathi E. Hanna, Consultant Sara Davidson Maddox, Editor IOM Staff Frederick (Rick) Erdtmann, Director, Medical Follow-Up Agency Andrew Pope, Director, Board on Health Sciences Policy Pamela Ramey-McCray, Administrative Assistant, Medical Follow-Up Agency Andrea Cohen, Financial Associate
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Irwin Feller Emeritus Professor of Economics Institute for Policy Research and Evaluation Pennsylvania State University Mauro Ferrari Ohio State University National Cancer Institute Mark Frankel Program Director American Association for the Advancement of Science
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs Hedvig Hricak Chair, Department of Radiology Memorial Sloan-Kettering Cancer Center Jerald Sadoff Chief Executive Officer Aeras Global TB Vaccine Foundation Richard L. Sprott Executive Director Ellison Medical Foundation Thomas P. Stossel American Cancer Society Professor of Medicine Harvard Medical School Palmer W. Taylor Sandra & Monroe Trout Professor of Pharmacology Dean, School of Pharmacy & Pharmaceutical Sciences University of California, San Diego Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Robert A. Frosch and Peter M. Howley. Appointed by the National Research Council and Institute of Medicine, respectively, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs Preface In 1992, in response to efforts of breast cancer survivors to direct more funding to understanding breast cancer and new and better ways to treat it, the U.S. Congress inserted a line-item in the fiscal year (FY) 1993 appropriation for the Department of Defense (DOD) that provided $210 million for peer-reviewed research on breast cancer. The U.S. Army Medical Research and Material Command implemented the congressional mandate by establishing the Breast Cancer Research Program (BCRP). Congress has not only continued to insert a line-item in the DOD budget each year for BCRP, it has added line-items for research on neurofibromatosis (FY 1996), prostate cancer (FY 1997), ovarian cancer (FY 1997), chronic myelogenous leukemia (FY 2002), tuberous sclerosis (FY 2002), and prion diseases (transmissible spongiform encephalopathies) (FY 2002). In addition, in FY 1999, Congress established a program of peer-reviewed research on military service-related topics, such as laser eye injury and trauma care. Collectively, these mandated activities are known as the Department of Defense Congressionally Directed Medical Research Programs (CDMRP). In recent years, CDMRP appropriations have totaled more than $350 million and funded more than 700 new awards annually to investigators in university, nonprofit research institutes, and in industrial, state government, and federal laboratories throughout the United States. CDMRP is distinguished by its emphasis on innovation, especially in translational research, achieved primarily by supporting new ideas and bringing in new investigators. CDMRP uses a peer review system recommended by a 1993 Institute of Medicine (IOM) report that was modeled after the National Institutes of Health (NIH) system, but with a notable addition, the participation—not just
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs representation—of patient advocates, then unprecedented and still unusual in government research programs. The peer review system is two-tiered, first reviewing research proposals for scientific quality, then reviewing them for programmatic relevance. Consumer advocates serve on both the first and the second-tier panels. CDMRP’s performance has met with the approval of scientists, the satisfaction of legislators and their constituents, pride on the part of the program’s administrators, and results. In 1992, DOD was downsizing in response to the end of the Cold War, and it was relatively easy to find room in the DOD budget for a program meeting an urgent public need. Today, in the aftermath of the September 11, 2001, terrorist attack, DOD’s budget situation is different. DOD’s mission has expanded to fight wars in Afghanistan and Iraq and maintain the peace in other hot spots around the world, and the demands on the DOD budget have escalated. There is heavy downward pressure on the other activities of DOD, including CDMRP, which had a budget of more than $390 million as recently as FY 2002. At the direction of Congress, DOD asked the Institute of Medicine to conduct a study exploring the possibility of attracting nonfederal funds to augment CDMRP’s appropriated funds. The IOM appointed a committee to identify sources and means of nonfederal funding that could augment CDMRP’s resources and strengthen it through creative partnering. The Committee was well aware of the larger context for biomedical research support, in which tight budgets not only affect CDMRP but also the largest source of public funds, the National Institutes of Health. Importantly, the charge was not to evaluate CDMRP or recommend whether it should be maintained, curtailed, or phased out nor to consider other sources of federal co-funding, such as NIH. Rather the task given was to assess the potential for leveraging nonfederal resources to achieve the goals of CDMRP. Members of the Committee sought to identify some innovative collaborative funding arrangements that CDMRP could use and that also could serve as models for other federal agencies and searched for imaginative solutions. For example, the Committee reviewed a variety of examples of innovative public-private cost sharing, partnerships, and other joint ventures in support of research and development (R&D), not only involving federal agencies, but also state and international agencies (examples are briefly described in Appendix A). A two-day workshop with presentations from representatives of nonfederal funding sources—including foundations, voluntary health agencies, universities, state research and economic development agencies, industry and venture capital—as well as of exemplary public-private research collaborations—was most informative and set the bases for models and sources that the Committee might realistically recommend (the workshop agenda is in Appendix C). Also, the Committee commissioned a paper reviewing economic studies of public-private collaboration in R&D and looked at the literature on the uses of cost-sharing and matching to augment federal research budgets (the paper is in Appendix D).
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs The report that follows assesses the extent of nonfederal sources of funding for research and details a variety of opportunities for leveraging nonfederal funding from the numerous sources examined. There are many examples in which the coordination of effort or the pooling of resources, or both, have leveraged research results that could not have been achieved otherwise. At the same time, the report is realistic about the extent to which these joint efforts are likely to generate a significant amount of additional resources for CDMRP. The Committee would like to thank the many individuals and organizations that provided information and expert judgment, especially those who participated in the workshop on short notice. They and their organizational affiliations are listed in the agenda for the workshop (Appendix C). Several organizations submitted statements which were carefully considered by the committee—the Amyotrophic Lateral Sclerosis Association on April 27, 2004, during the public statement period of the workshop, and the National Coalition for Osteoporosis and Related Bone Diseases on May 20, 2004, by letter. Others who assisted were Greg Downing, National Cancer Institute; Neil Buckholtz and Susan Molchan, National Institute on Aging; James Schuttinga and Karen Pla, Office of the NIH Director; John Lowe and Kelly Robbins of the Henry M. Jackson Foundation for the Advancement of Military Medicine; Geoffrey Frisch of the Centers for Disease Control Foundation; and John Moore, CDC. The CDMRP staff was most helpful, including the director, Col. Kenneth Bertram, M.D., Ph.D., deputy director, Lt. Col. Calvin Carpenter, and several program directors, including Patricia Modrow, Ph.D., Leo Giambarresi, Ph.D., and Richard H. Kenyon, Ph.D. I would like to thank the members of the Committee, who took on this assignment on short notice and attended three meetings and the workshop in a compressed time frame. The mix of expertise and experience was stimulating and well suited for the task. We learned from each other and came to know and regard well this significant biomedical research enterprise of the Department of Defense. Finally, I would like to thank the study staff for the superb job they did at all levels despite the constraints imposed by a six-month deadline. Joseph S. Pagano, M.D. Chair
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs Contents EXECUTIVE SUMMARY 1 1 INTRODUCTION 13 DOD’s Congressionally Directed Medical Research Programs, 13 Impetus for This Report, 20 Overview of the Current CDMRP, 21 The Committee’s Approach to Its Task, 32 2 SOURCES OF FUNDING FOR BIOMEDICAL RESERCH 37 The Federal Government, 38 Private Industry, 41 Venture Capital, 42 Academia, 43 Philanthropic Organizations, 44 State Governments, 47 Summary, 52 3 EXAMPLES OF LEVERAGING NONFEDERAL DOLLARS FOR RESEARCH 55 Cost Sharing or Matching Required of Awardees, 56 Voluntary Cost Sharing by Awardees, 60 Nonfederal Funding Secured by Federal Agencies, 61 Nonfederal Funding Volunteered to Federal Agencies, 64 Conclusion, 69
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs 4 ASSESSMENT OF ALTERNATIVE SOURCES AND MECHANISMS OF NONFEDERAL SUPPORT 71 Potential Advantages and Disadvantages of Cost Sharing and Matching Requirements, 71 Agency Experiences with Cost Sharing, 74 Voluntary Collaborations, 77 Impacts of Alternatives on the Current Program, 81 Changes in Federal Laws and Regulations Required by Alternative Funding Sources and Mechanisms, 84 Summary, 87 5 FINDINGS AND RECOMMENDATIONS 91 APPENDIXES A SELECTED FEDERAL PROGRAMS WITH NONFEDERAL FUNDING PARTICIPATION 99 B BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS 133 C WORKSHOP AGENDA 137 D “LEVERAGING PUBLIC INVESTMENTS WITH PRIVATE SECTOR PARTNERSHIPS: A REVIEW OF THE ECONOMICS LITERATURE” Andrew A. Toole and Anwar Naseem, Rutgers University 141
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs Figures, Tables, and Boxes FIGURES 1-1 CDMRP budget and program planning and execution cycle, 25 1-2 Distribution of extramural award funding among types of research support, FY 2002, 28 1-3 Distribution of extramural award funding among areas of research, FY 2002 (in percentages), 29 2-1 Foundation grant dollars by purpose, 2002, 45 TABLES 1-1 CDMRP Award Results, FY 1993-FY 2003, 19 1-2 Funding History of CDMRP Core Programs (in millions of dollars), 24 2-1 Federal Obligations for Health R&D by Source, FY 1997-FY 1999 (in millions of dollars), 39 2-2 Expenditures for Biomedical and Behavioral R&D at Universities and Colleges, FY 2001 (in thousands of dollars), 43 2-3 The 12 Largest VHAs in Research Grant Expenditures, FY 2002, 46 3-1 Typology of Federal/Nonfederal Funding Arrangements, 56
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs BOXES 1-1 CDMRP Core Programs, 26 2-1 The CDC Foundation, 40 2-2 The Juvenile Diabetes Research Foundation International, 48 2-3 Example of State-Funded Biotechnology Development: North Carolina Biotechnology Center, 51 2-4 Example of State-Funded Medical Research: Ohio’s Third Frontier Project, 52 4-1 Avon Foundation-NCI “Progress for Patients” Awards Program, 80 4-2 FNIH, 86 4-3 Example of a TIA, 87 D-1 Examples and Objectives of “Social Venture Capital” in International Health, 163
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs Abbreviations and Acronyms AAFRC American Association of Fundraising Counsel ABC2 Accelerate Brain Cancer Cure ABCC administrative and bioinformatics coordinating center ACCP Alliance for Cervical Cancer Prevention AD Alzheimer’s disease ADA American Diabetes Association ADNI Alzheimer’s Disease Neuroimaging Initiative AHA American Heart Association AICR American Institute for Cancer Research ALS amyotrophic lateral sclerosis AP4 Academic Public-Private Partnership Program ARL Army Research Laboratory ARMF Applied Research Matching Fund ATP Advanced Technology Program AUTM Association of University Technology Managers BCRP Breast Cancer Research Program BIO Biotechnology Industry Organization BRCAl breast cancer 1 gene Bt Bacillus thuringiensis CAD Canadian dollar CAL-(IT)2 California Institute for Telecommunications and Information Technology
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs CBCRP California Breast Cancer Research Program CDC Centers for Disease Control and Prevention CDMRP Congressionally Directed Medical Research Programs CF cystic fibrosis CFF Cystic Fibrosis Foundation CFFT Cystic Fibrosis Foundation Therapeutics, Inc. CIA Central Intelligence Agency CIHR Canadian Institutes of Health Research CITRIS Center for Information Technology Research in the Interest of Society CMLRP Chronic Myelogenous Leukemia Research Program CNSI California Nanosystems Institute CRADA Cooperative Research and Development Agreement CSI Congressional Special Interest CSO Common Scientific Outline DARPA Defense Advanced Research Projects Agency DCA Defense Cooperation Account DFID Department for International Development DHHS Department of Health and Human Services DNA deoxyribonucleic acid DOD Department of Defense DOE Department of Energy DTI Department of Trade and Industry DUS&T Dual Use Science and Technology (DUS&T) Program EMBRAPA Brazilian Agricultural Research Corporation (Empresa Brasileira de Pesquisa Agropecuária) EPA Environmental Protection Agency ERC Engineering Research Center FDA Food and Drug Administration FNIH Foundation for the National Institutes of Health FY fiscal year GC Genome Canada GICUR Government/Industry Co-sponsorship of University Research Program GUIRR Government-University-Industry Research Roundtable HEFCE Higher Education Funding Council of England HEI Health Effects Institute HER2 Human Epidermal Growth Factor Receptor 2
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs HHMI Howard Hughes Medical Institute HIPAA Health Insurance Portability and Accountability Act HTP Human Transcriptome Project IAVI International AIDS Vaccine Initiative ICR Islet Cell Resource Center IDEA Innovative Developmental and Exploratory Awards IOM Institute of Medicine IP intellectual property ISS International Space Station ITN Immune Tolerance Network I/UCRC Industry/University Cooperative Research Centers Program IUCRP Industry-University Cooperative Research Program JDRF Juvenile Diabetes Research Foundation International JIF Joint Infrastructure Fund KTEC Kansas Technology Enterprise Corporation LLNL Lawrence Livermore National Laboratory MARCO Microelectronics Advanced Research Corporation MDA Muscular Dystrophy Association MDCRC Muscular Dystrophy Cooperative Research Center Program MIM Multilateral Initiative on Malaria MMV Medicines for Malaria Venture MRSEC Materials Research Science and Engineering Centers Program MSC Mouse Sequencing Consortium MTA-CRADA material transfer agreement CRADA NASA National Aeronautics and Space Administration NBCC National Breast Cancer Coalition NCBC North Carolina Biotechnology Center NCI National Cancer Institute NCRA National Cooperative Research Act NCRR National Center for Research Resources NEI National Eye Institute NF neurofibromatosis NFRP Neurofibromatosis Research Program NGA National Governors Association NGO nongovernmental organization NHGRI National Human Genome Research Institute NHLBI National Heart, Lung, and Blood Institute
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs NIA National Institute on Aging NIAID National Institute of Allergy and Infectious Diseases NIAMS National Institute of Arthritis and Musculoskeletal and Skin Diseases NICHD National Institute of Child Health and Human Development NCRR National Center for Research Resources NIDCR National Institute of Dental and Craniofacial Research NIDDK National Institute of Diabetes and Digestive and Kidney Diseases NIEHS National Institute of Environmental Health Sciences NIH National Institutes of Health NIMH National Institute of Mental Health NINDS National Institute of Neurological Disorders and Stroke NINR National Institute of Nursing Research NIST National Institute of Standards and Technology NSB National Science Board NSEC Nanoscale Science and Engineering Centers Program NSF National Science Foundation NVCA National Venture Capital Association OAI Osteoarthritis Initiative OCRP Ovarian Cancer Research Program OIG Office of Inspector General OIT Ontario Innovation Trust OMB Office of Management and Budget ORDCF Ontario Research and Development Challenge Fund ORMH Office of Research on Minority Health ORWH Office of Research on Women’s Health OST Office of Science and Technology PCRP Prostate Cancer Research Program PFI Partnerships for Innovation PhRMA Pharmaceutical Research and Manufacturers of America PPP public-private partnership PRMRP Peer Reviewed Medical Research Program QB3 California Institute for Bioengineering, Biotechnology, and Quantitative Biomedical Research R!A Research!America R&D research and development RAD Research Area Directorate RFA Request for Applications
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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs RFP Request for Proposals RJV research joint venture SARS Severe Acute Respiratory Syndrome SBIR Small Business Innovation Research Program SEMATECH Semiconductor Manufacturing Technology Consortium SGC Structural Genomics Consortium SPD Space Partnership Development SPORE Specialized Programs of Research Excellence SRIF Science Research Investment Fund SSTI State Science and Technology Institute STAR Strategic Technology and Research Fund STC Science and Technology Center STTR Small Business Technology Transfer Program T1DGC International Type 1 Diabetes Genetics Consortium TATRC Telemedicine and Advanced Technology Research Center TB tuberculosis TCRF Technology Commercialization Research Fund TDN Therapeutic Development Network TEDDY Triggers and Environmental Determinants of Diabetes in Youth TGEN Translational Genomics Research Institute TIA Technology Investment Agreement TMM Technologies for Metabolic Monitoring TOBI tobramycin solution for inhalation TSCRP Tuberous Sclerosis Complex Research Program UC University of California UK United Kingdom U.S. United States USAMRDC U.S. Army Medical Research and Development Command USAMRMC U.S. Army Medical Research and Materiel Command USDA U.S. Department of Agriculture VA Department of Veterans Affairs VHAs voluntary health agencies WHO World Health Organization
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