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Dear friends,
I am sending solidarity to all of you in these challenging times. Soon I’ll be leaving my routine, taking six weeks away from work to travel with my family. The last time I took this much time off was back in the twentieth century! I hardly know how to feel. Today I want to share the long and winding road that led to our latest funded grant. I’m putting in some NIH inside baseball, but there are broader lessons too.
My friend and colleague Ma Somsouk and I first brainstormed our project idea, to improve follow-up of our patients with abnormal colon cancer screening stool tests with the colonoscopy, in 2016, when we submitted it as a U01 application. It was scored but not funded. Encouraged, we submitted it as an R01 grant to a disparities program announcement at NIH in 2017, and it was triaged. Then the revision cycle came around for the U01, also in 2017, and the score improved, but not to the funding line. In 2018, we put it in to a different NCI program announcement on follow-up of abnormal cancer screening, and it was not discussed at the HSOD (health services) study section. In February 2019, we made some design changes and put it in to the same program announcement as a new grant, and it went to the HDEP (disparities) study section, where it scored at the 25th percentile. The revised version submitted in November 2019 scored at the 14th percentile at the same study section, which heartbreakingly just missed the funding line.
Undeterred, we put it in as a new submission in June 2020, and it was assigned to what was clearly the wrong study section, CMPC, which evaluates community-based interventions and has a heavy nursing focus. We begged and pleaded to have it re-assigned to the disparities study section, even going to the NIH branch chief and the managers at the Center for Scientific Review, but they would not change it. The grant was reviewed by the wrong scientists and fared poorly- not discussed. After processing our feelings, we decided that since we had been so close to the funding line back in 2019, we would try again as a new submission. We submitted in June 2021 and got a score of 18, which put us at the 2nd percentile, and after months of delays, were funded with a notice of award of May 15, 2022.
What did we learn from this process? Of course, this true story shows the flaws in the NIH grant review process, but there is more to take away. First, we paid attention to the positive signals. Even though our first submission wasn’t funded, it was scored, and we took that to mean our idea had promise. Second, we found our audience. When we got in front of the experts in disparities science, they understood the problem and how our study fits the context. The most brilliant science can’t succeed if the reviewers are not appropriate. Third, it takes the right team. Having a joint PI who wouldn’t give up kept me in it, and I think I did the same for him. Our lab program manager, Sarah Lisker, has been with us since that first submission and shares our commitment to health equity. We could all remind each other that we are doing this for our patients and draw motivation from our shared mission. The final lesson comes from the fact that in the five years since we proposed this study, no-one else has done what we are proposing to do. Our idea is still innovative, so why would we stop trying?
I share this saga in the hopes that you can learn in a less painful way than we did from our experience. After all this time, we are excited to roll up our sleeves and get to work using digital technology and teamwork to diagnose colon cancer early, when it’s curable and treatable, among all our patients.
I look forward to hearing from all of you when I’m back from my vacation in late July. I hope this summer brings some respite, peace, and rest for all of you. Please share widely, and feel free to subscribe here at the bottom of the page if you’d like to receive my monthly email.
Warmly,
Urmimala