Date: May 18, 2007
Place: Building 31, Conference Room 10
National Institutes of Health
Bethesda, Maryland
U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
The 185th meeting of the National Advisory Dental and Craniofacial Research Council (NADCRC) was convened on May 18, 2007, at 9:00 a.m., in Building 31, Conference Room 10, National Institutes of Health (NIH), Bethesda, Maryland. The meeting was open to the public from 8:30 a.m. to 12:00 p.m. followed by the closed session for Council business and consideration of grant applications from 1:00 p.m. until adjournment at 3:00 p.m. Dr. Lawrence A. Tabak presided as Chairman and upon his departure for another meeting at 10:30 a.m., Dr. Isabel Garcia, Deputy Director, NIDCR, served as Chairwoman for the remainder of the meeting.
Members Present:
Dr. Gilda Barbarino
Dr. Matthew J. Doyle
Dr. Marianne Bronner-Fraser
Dr. Eli Capilouto
Dr. Augusto Elias-Boneta
Dr. Cecile Feldman
Dr. Josephine Lai
Dr. Jon D. Levine
Dr. Anne S. Lindblad
Dr. Harold Morris
Dr. Malcolm Snead
Dr. Philip Stashenko
Dr. George Taylor
Members of the Public Present:
Mr. Peter Anas, Friends of NIDCR, Washington, DC
Mr. Jack Bresch, America Dental Education Association, Washington, DC
Dr. Yolanda Bonita, Friends of NIDCR, Washington, DC
Mr. Cliff Carey, American Dental Association, Washington, DC
Dr. Aida Choya, Women’s Network Research, Rockville, MD
Dr. Robert Collins, University of Pennsylvania, Philadelphia, PA
Dr. Christopher Fox, American Association for Dental Research, Alexandria, VA
Dr. Franklin Garcia-Godoy, Nova Southern University, Fort Lauderdale, FL
Nasreen Jahed, SSS, ACTO
Michelle Johnson, BOP
Dr. Denis Kinane, University of Louisville School of Dentistry, Louisville, KY
Dr. Peter Murray, Nova Southern University, Fort Lauderdale, FL
Linda Naini, SSS
Mr. Daryl Prichard, American Association of Dental Research
Dr. John Rugh, UTSHC, San Antonio, TX
Dr Richard Valachovic, American Dental Education Association, Washington, DC
Federal Employees Present
National Institute of Dental and Craniofacial Research:
Dr. Lawrence A. Tabak, Director
Dr. Isabel Garcia, Deputy Director
Dr. Norman S. Braveman, Executive Secretary, NADCRC and Assistant to the Director
Dr. Robert C. Angerer, Scientific Director, Division of Intramural Research (DIR)
Dr. Jane Atkinson, Program Director, Clinical Trials Program, Center for Clinical Research (CCR)
Dr. Albert Avila, Extramural Training Officer, DEA
Dr. Henning Birkdal-Hansen, Associate Director for Program Development
Dr. María Teresa Canto, Program Director, Health Promotion and Community-Based Research Program, CHPBR
Mr. Hong Cao
Mr. George J. Coy, Chief, Financial Management Branch (FMB), Office of Administrative Management (OAM)
Ms. Mary Daley, Chief Grants Management Officer, GMB, DEA
Mr. Bret Dean, Budget Analyst, FMB, OAM
Dr. Alicia Dombroskwi, Deputy Director, Division of Extramural Activities
Dr. Kevin Hardwick, Chief, Research Training and Career Development Branch, DEA
Ms. Kathy Hayes, OD
Ms. Mary Kelly, Scientific Review Specialist, Scientific Review Branch (SRB), DEA
Ms. Sooyoun Kim, Scientific Review Specialist, SRB, DEA
Dr. Lynn M. King, Scientific Review Administrator, Scientific Review Branch (SRB), DEA
Dr. Eleni Kousvelari, Acting Director, CBI
Dr. John W. Kusiak, Director, Molecular and Cellular Neuroscience Program, CIBID
Ms. Yujing Liu, Scientific Review Administrator, SRB, DEA
Ms. Carol Loose, Budget Analyst, FMB, NIDCR, OAM
Dr. Nadya Lumelsky, Program Director, Tissue Engineering and Regenerative Dental Medicine Program, CBI
Mrs. Jayne Lura-Brown, Program Analyst, CHPBR
Ms. Amy McGuire, NIDCR
Dr. Pamela McInnes, Director, CIBID
Dr. Mostafa Nokta, Program Director, AIDS and Immunosuppression Program, CIBID
Dr. Ruth Nowjack-Raymer, Program Director, Health Disparities Research Program, CCR
Ms. Helen Pham, NIDCR
Dr. Bruce Pihlstrom, Acting Director, CCR, and Program Director, Clinical Trials Program, CCR
Ms. Dede Rutberg, DEA
Dr. Yasaman Shirazi, Program Director, Epithelial Cell Regulation and Transformation Program, CIBID
Dr. Lillian Shum, Program Director, Mineralized Tissue and Salivary Gland Physiology Program, CIBID
Dr. Rochelle Small, Program Director, Developmental Biology and Genetics Program, CIBID
Ms. Traci Walker, Committee Management Assistant, OD
Dr. Peter Zelazowski, SRB
Other Federal Employees:
Dr. Sheng, Lin-Gibson, NIST
OPEN SESSION
I. WELCOME AND INTRODUCTIONS
Dr. Lawrence A. Tabak, Director, NIDCR, called the meeting to order and welcomed everyone. He invited the meeting guests to introduce themselves. Expressing appreciation for his service to NIDCR, Dr. Tabak announced that Dr. Bruce Pihlstrom would be retiring from federal service, which included five years with NIDCR. He contributed significantly to the clinical research program.
II. TRAINING ISSUES UPDATE
Dr. Kevin Hardwick
Dr. Hardwick introduced the subject by asking the basic question that would be considered during discussion – what should be the goals and outcomes of the NIDCR training program?
NIDCR is examining the management of institutional and individual training, which includes two basic types of funding grants. T32 trainees are funded through institutional grants to selected institutions which, in turn, select the trainees through an internally-designed process. Individual F fellows apply individually to, and are reviewed, selected and funded by NICDR. Pre-doctoral dual degree (DDS/Ph.D. or DMD/Ph.D.) trainees are eligible to apply for F30 fellowships; post-doctoral trainees are eligible for F32 grants. One of the issues being considered by NIDCR is whether to require trainees to apply for fellowships.
A recently-released study of career achievements of NRSA post-doctoral trainees (supported by institutions) and fellows (supported directly by an NIH institute) over almost 30 years (1974-2004) indicated that there was a significant difference in career outcomes. They were compared to each other and to candidates who applied for NRSA grants but were unsuccessful and to other postdocs who were not supported by either institutional or direct NIH grants.
The study revealed that NIH fellows did better than trainees in obtaining later R01 or equivalent funding. More fellows applied for grants than trainees (53% versus 38%), and more fellows actually received grants than trainees (67% versus 53%). The funding success rate of trainees and the unsuccessful candidate group was about the same. An analysis of NIDCR trainees and fellows (a different cohort than the study population) revealed a similar performance variation with regard to applications (48% versus 33%), but different for receiving funding – the NIDCR trainees were more successful than the study cohort. Both NIDCR trainees and fellows were funded at about the same rate. Fellows submitted more applications and therefore received a greater number of grants.
Dr. Hardwick explained that the NIDCR study looked at every trainee from 1975 through 2005 and only 6% applied for F32 awards (fewer than 70 out of 1,142 trainees); 62% were awarded fellowships. Interestingly, over the years the average application rate was 6%, but broken into three ten-year periods the rate declined from 11% in the first period to only 3% in the most recent period. Dr. Hardwick suggested that there may be value in requiring T32 trainees to apply for fellowships. Even if unsuccessful, the experience of preparing the application would be worthwhile -- trainees have nothing to lose except the time and effort to prepare the application.
Dr. Hardwick turned to consideration of the NIDCR Dental Scientist Training Program (DSTP), and provided a comparison with the model used in NIGMS’ Medical Scientist Training Program (MSTP). That program provides a 7-8-year integrated MD/Ph.D program that combines courses usually taken in the first two years of med school and graduate school, followed by 3-4 years of research and dissertation preparation, ending with two years of clinical med school courses. NIGMS provides funding for 6 years; the institution covers the remaining costs through a maximum of 8 years. The program is highly competitive, and many candidates apply for these training positions.
Finally, Dr. Hardwick noted that there has been a focus at NIDCR on the DDS/Ph.D dual degree, and 42 T32 trainees pursuing dual degrees are currently enrolled in 12 dental schools (44% of all NICDR T32 trainees). NIDCR is also supporting approximately 35 others who are either enrolled in dual degree programs or who are dentists getting a subsequent PhD – bringing the total to about 77 people who are in the pipeline to have both dental and PhD degrees.
Dr. Hardwick closed by reiterating the basic questions that apply to the NIDCR training program: 1) Do the dual degree postdocs who complete the various programs complement the needs of the research workforce, i.e., are there jobs available upon completion? 2) Do the graduates need clinical specialty training to make their research more relevant or only to compete in the marketplace? 3) Whether or not NIDCR contributes to helping dental schools build a research infrastructure, does it exist to the extent that students are aware of it?
III. BUILDING AN ORAL HEALTH RESEARCH INFRASTRUCTURE: WHAT WE’RE DOING; WHAT’S NEXT
Dr. Henning Birkedal-Hansen
Dr. Birkedal-Hansen explained that most dental schools are under-funded versus the mandate of their missions, which frees up few funds for investment in future enterprise. A few years ago the NIDCR developed a program to provide some support to help dental schools strengthen research capabilities through more effective recruitment of research scientists, acquisition of equipment and materials (infrastructure support), and development of institutional partnerships. The program was launched in 2002 with two one-year planning grants to minority institutions, followed in 2003 by 15 similar grants limited to institutions that had less than $6 million in NIDCR support. In 2004, seven dental schools received $2 million each under two-year Cooperative Agreements (a U24 --a type of grant that allows NIDCR to maintain a significant management function during the life of the grant).
There was a preliminary evaluation in January 2007 that revealed that six of the schools had attracted magnet investigators, senior scientists already well established in the research community, but only one of those was from outside the traditional oral/dental research community. Seven mid-level researchers were recruited, two from outside, and 32 junior investigators were recruited, 13 from outside.
The development of external institutional linkages was judged by a number of testimonials submitted by the schools. It was clear that the funding had improved the quality of the research and had established or improved the relationships and partnerships within the university health sciences centers, including in some cases a leveraging of funding. In general, the evaluation showed an increased collaboration within the dental department and with other sciences at the institutions and a positive impact on pre-doctoral dental education.
Concerning the future of the program, Dr. Birkedal-Hansen introduced three issues for Council consideration: 1) Whether or not to continue the same program for another tier of schools; 2) whether to expand the program to include all dental schools, even those with solid existing infrastructure and/or more than $6 million in NIDCR funding; and 3) whether to focus on the best research opportunities without regard to other issues.
IV. DISCUSSION OF THE NIDCR TRAINING PROGRAM
During discussion, Dr. Stashenko noted that the evaluation of the infrastructure development program was, in large part, anecdotal and that more specific evaluation criteria should be developed. The judgment should be based on return on investment with defined metrics, some type of scorecard for each institution that might track things like new partnerships and collaborations, new funding as a result of the NIDCR grants, and identifiable research results (such as publications). The evaluation should be annual. Dr. Hardwick noted that, although the evaluation criteria could be more specific, it is not practical to measure the institutions against each other since they are not starting on a level playing field. For example, some had more infrastructure to begin with and could use the funding for recruiting and developing collaborations, while others were starting from a more basic level and had to invest in recruitment of a magnet investigator and in purchasing equipment.
There were a number of suggestions -- that there should be an objective way to judge whether to sustain the funding, whether institutional matching funds should be an important consideration in that judgment, whether an award could be made to enable the recruitment of a specific high profile researcher (funding dedicated to that individual). Dr. Bronner-Fraser commented that dental schools are facing financial challenges more serious than in several decades, and the effective funding could help them be more competitive among the various other departments on campus. She added that the funding could give the dental school a strengthened platform which, among other things, could contribute to building an effective mentoring corps.
There was a brief discussion about developing a tool, perhaps a course or courses, which would equip all dental students with a basic knowledge of the research process and research ethics. It was observed that few dental schools provide the opportunity to participate in research, partly because the basic course work is so intense and partly because students simply don’t have the interest. There was a suggestion that developing a research-centered pipeline beginning in K-12, or at least in high school, would be a positive step.
There was a suggestion that rebalancing the funding between the T32 and F30 programs was suggested by the study comparing achievements. The Fellows program would appear to offer greater return on investment. To encourage trainee applications, a program might assign a seasoned researcher to help students prepare applications and the institution could provide additional incentives for both individuals and institutions to encourage the application effort. It was noted that NIDCR allocates about 9% of its budget to training and career development, a substantial amount -- but the results are not clear. Perhaps there should be a renewed effort to evaluate those results.
Dr. Tabak described a new approach in medical training – Ph.D. candidates who take courses in pathobiology to expand their view to include a medicine component. That could be done for science pre-docs, to expose them to dental medicine and dental research. The point is, to contribute to dental research one does not have to have a dental degree. Additionally, if research is isolated from the dental school culture, as has been alleged, it will be difficult to develop an awareness of evidence-based research among those pursing a clinically-based degree. Finally, there is another dilemma that needs to be addressed. Dual degree postdocs without a specialty often end up in limbo, where there are few worthwhile employment opportunities.
Asked about the DSTP, Dr. Tabak noted that it was a work in progress with only the first cohort completing training. They appear to be continuing with specialty training and whether they will return to the lab or to a clinical practice it not clear. It was noted that the MSTP was a similar program in medicine, with dual degree graduates continuing with subspecialty training, but a substantial number appear to return to academia. Dr. Tabak explained that the subspecialty training in medicine has a substantial research component and that GME supports training in medical subspecialties, a benefit not presently available to the dental specialties. There was an observation that the dental school curriculum is intense, almost a year-round obligation, because the schools combine a residency with training unlike medical schools that train and then send graduates into residencies). It was suggested that NIDCR consider championing a change in the curriculum philosophy that would give students more time to participate in research programs, perhaps during a summer break presently unavailable. Dr. Tabak commented that there is a nascent sentiment at the national level that supports the concept.
Dr. Tabak stated that the discussion had been valuable and that he would like Council members to consider volunteering to serve on one of two ad hoc subgroups – one to look at opportunities related to infrastructure, and the other to look at training issues. Dr. Braveman suggested that interested Council members could send him an e-mail and he would organize the subgroups. It was suggested that both of the subgroups would appreciate having data related to the two tasks. For example, it would be helpful to have more detail about the achievement study and about the history of T and F grants at NIDCR. Dr. Hardwick stated that the financial data is readily available, but that most of the reports from grantees are in narrative form and not reduced to a database format. Dr. Christopher Fox, American Association for Dental Research, volunteered that his association would be amenable to providing member data that might be helpful, and that the association would also be willing to provide a forum for information gathering among the dental research community it serves. Dr. Valachovic, American Dental Education Association, commented that there are few dental DSTPs, and that efforts to increase the number is important.
In summary, Dr. Tabak commented that staff will look into the data needed by the subgroups to work effectively on the two issues. He added that clinical and translational science awards (CTSAs) represent an opportunity to access that area of dentistry where much of the research focus is. He expressed appreciation for the contributions to the discussion, and announced that he would have to leave to attend another meeting. Dr. Garcia would assume the responsibilities of chair.
V. APPROVAL OF MINUTES
Dr. Braveman, executive secretary of the Council, invited approval of the minutes of the January 22, 2007 Council meeting. On motion duly made and seconded, the minutes were unanimously approved.
VI. REPORT OF THE DIRECTOR, NIDCR
In Dr. Tabak’s absence, Deputy Director Isabel Garcia presented the Report of the Director.
Dr. Garcia reported that Dr. Tabak was involved in a number of trans-NIH activities, including the NIH Steering Committee and a number of working groups. His active participation contributes to making NIDCR an integral member of the NIH scientific community.
Dr. Garcia noted that the call for public comment on the 2009 initiatives would close on May 22. Public comment has been important in the agenda-setting process, and it has improved in both quantity and quality during that last few years.
She noted the retirements of two long-time members of the NIDCR staff, Dr. Patricia Bryant and Dr. Alice Horowitz.
Dr. Garcia described her participation in the initial deployment of the USNS Comfort, one of two Navy hospital ships, which will be part of an extended deployment to Latin America of a team composed of personnel from the Public Health Service Commissioned Corps, the Department of Health and Human Services, and the U.S. Navy Southern Command. Although this first deployment was primarily a planning deployment, the subsequent deployment, which is scheduled to begin in June, will provide direct patient care to populations in need, training of local health care workers, an effort to coordinate the services of a number of NGOs involved in health care in the various regions, and infrastructure support. The Comfort will visit 12 countries.
Dr. Garcia described her role in the planning of the dental segment of the program. The Comfort, a huge ship almost a thousand yards long, has about a thousand beds, several operating rooms, and will carry 80 to 100 health care professionals to provide services on board and ashore. In addition to routine medical services, the host nations were particularly interested in diagnostic services, especially those requiring equipment such as MRIs, environmental support (e.g., help in providing clean water), and training for local health care workers. In her trips ashore, Dr. Garcia saw that in some places the medical equipment was old, often inoperative, and the mission intends to provide a group of technicians to effect repairs, procure spare parts, and provide instruction in maintaining and operating the equipment.
Dr. Garcia described some of the dental facilities – older buildings, some of which lack electricity, older or non-functioning equipment, limited access to anesthesia, a dentist who visits occasionally and who is restricted in the services offered partly because of the lack of anesthesia. The dental support personnel appear to be knowledgeable, but they face serious infrastructure challenges since large numbers of people show up when the dentist is available, all needing shelter, food, water and security during their visits.
Asked about standard of care, Dr. Garcia commented that in many areas it is not possible to have the standard of care available either in the United States or wherever the Comfort visits. Asked about prevention, Dr. Garcia stated that water fluoridation is only available in a few cities visited, and that fluoride treatment, like anesthesia, is not readily available in most places.
Dr. Garcia adjourned the open session at 12:00 p.m., to reconvene in closed session at 1:00 p.m.
CLOSED SESSION
This portion of the meeting was closed to the public in accordance with the determination that it was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix 2).
REVIEW OF APPLICATIONS
ADJOURNMENT
The meeting was adjourned at 3:00 p.m.
CERTIFICATION
I hereby certify that the foregoing minutes are accurate and complete.
________________________ _________________________
Dr. Lawrence A. Tabak Dr. Norman S. Braveman
Chairperson Executive Secretary
National Advisory Dental and National Advisory Dental and
Craniofacial Research Council Craniofacial Research Council
ATTACHMENTS
I. Roster of Council Members
II. Table of Council Actions
III. Director’s Report to the NADCRC, September 2006
NOTE: A complete set of open-portion handouts is available
from the Executive Secretary.