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The National Institutes of Health (NIH) grant-making process is slow, even during a pandemic

StatNews reports that the NIH is “a slow-moving glacier” and that the agency’s “sluggish and often opaque efforts to study long Covid draw patient, expert ire.” The news get worse: Congress allocated $1.2 billion to study long COVID, but “so far the NIH has brought in just 3% of the patients it plans to recruit.” The major defense of one NIH employee? The $1.2 billion effort is moving “much faster than we’ve done anything else before” and the NIH’s “usual pace can be even slower.” How reassuring. Unfortunately, the NIH’s Covid-19 response is typical; as we wrote in August 2021, the federal grant-making apparatus is so slow that the private “Fast Grants” initiative attempted to do just what its name implies: make grants fast. And it did: within days at first, and then within two weeks. By contrast, the NIH has never learned how to go fast, and, as far as we can tell, neither have other federal agencies (although HRSA did eventually kick out some telemedicine money faster than we’d have imagined).

Why haven’t federal agencies learned to go fast? I think part of the answer is poor feedback mechanisms. No federal agency goes out of business from moving slowly—no one loses a job, money, or anything else. If even a pandemic can’t shake NIH out of their torpor, what will? A war? Maybe. We couldn’t even bother to make substantial modifications to the absurd clinical trials process during the COVID-19 pandemic, and instead relied primarily on throwing more money at the problem, while NIH continued to crawl at a snail’s pace.

America does the same thing with infrastructure construction: instead of reforming and eliminating bureaucratic rules to reduce the cost of building new infrastructure, we attempt to throw money at the problem until we manage to (partially) bulldozer our way through it. The problems being that the “throw money at it” solution takes way too long, costs too much, and leaves us with too little infrastructure at the end. But there is no single Directly Responsible Individual (DRI) for bureaucratic rules, so nothing changes—much like the stalled COVID study. The StatNews article notes that “A group of two dozen COVID-19 experts recently released a report that excoriated the NIH’s progress as well, noting that recruiting for the study has been painfully slow” and that “The experts argued the Biden administration should create a long COVID task force to hold agencies accountable for progress.” Unless the task force has the power to fire, demote, and restructure, it’s unlikely to achieve much.

Speed is important for many reasons, one being that the faster you can do something, the more you can do of the thing, and the sooner you can get feedback. One sees this feedback process—sometimes called the “Observe, Orient, Decide, and Act” (OODA) loop—in all sorts of endeavors: as the loops tightens, more of the thing gets done, or learned. In computer programming, for example, compiling or deployment that used to take hours or days now happens instantly, allowing for fast feedback to programmers, and letting the programmers get better, fast. Something similar is true in writing: the faster a person writes and gets useful critical feedback, the quicker the revision process becomes (assuming the editor is good and the writer in an improvement mindset).

The opposite is also true: as noted above, our bloated infrastructure rules from laws like the National Environmental Policy Act (NEPA) and California Environmental Quality Act (CEQA) mean that building things like subway or light rail line extension takes a decade and costs billions of dollars. So we build that infrastructure with such agonizing slowness that we never get network effects going, and most people talk of “toy trains” that “go to nowhere,” and, unfortunately, they have a point: if it takes 10 or more years to build a few miles of rail, most people are going to scoff at that rail. The road to improving the U.S.’s transit emissions starts with reforming NEPA. The law is supposedly designed to improve the environment, but instead it locks in the current system, which is not very climate friendly—the law is having the exact opposite of its intended effect.

By the time the NIH completes its studies, the studies might not matter any more. It’s like a person taking five years to decide to ask someone to get married: by the time person 1 asks, person 2 may already be married and have kids. If you wait sufficiently long, opportunities disappear.

Failure to study COVID with sufficient speed will leave people suffering, and possibly dead. That is bad. Despite it being bad, no one seems able or willing to attempt to overcome the problem.

If you don’t think speed and attention matter, try writing anything substantive with interruptions every few minutes: you’ll never get anywhere, and the end result will be unpalatable.

I wish I had a solution to these problems, but I don’t. The normal grant-making process works on a “good enough” basis, and it is typically more about redistributing money to favored communities and populations of focus than truly achieving the nominal goal of whatever the grant-funded program happens to be. Once you realize that, the rest of the system’s apparent peculiarities fall into place. Unless and until Congress wants to make substantial changes to how the federal government works, I think we’re likely to see business-as-usual continue. By far, the most successful part of the federal response to COVID was Operation Warp Speed, which rapidly kicked money to the usual suspects, in the form of pharma companies, and made pre-committments to buy large numbers of vaccine doses even if the clinical trials didn’t work out, such that trials could be conducted quickly and, if the money is “wasted” on ones that don’t work out, that “waste” is trivial relative to the amount of benefit from even a single successful trial.

Warp Speed operated at warp speed, while the NIH is still ambling along in a buggy. That’s been our experience with federal grant-making agencies: they stroll along, and nothing can or will hasten them. That’s a shame, because the country and world face real problems. As with NEPA and CEQA, however, many problems are mandated by legislators, or increased by the rule-making machinery, and no one with sufficient clout seems interested in solving them. These problems also don’t map neatly to right or left ideological talking points. The answer to whether we need “more” or “less” government, for example, is that we need more efficient and effective government, which is neither “more” or “less:” it’s orthogonal to that question, and the solutions aren’t amenable to sound bites.

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Confusing NIH and other Small Business Innovation and Research (SBIR) application guidance

In theory, an “application guide” for a Small Business Innovation and Research (SBIR) grant from a federal agency is meant to make the application process easier: the applicant should presumably be able to read the application guide and follow it, right? Wrong, as it turns out. The difficulties start with finding the application guide and associated RFP (or “FOA,” Funding Opportunity Announcement in NIH-land) . If you go to grants.gov today, Sept. 9, dear reader, and search for “SBIR,” you’ll get 74 matching results—most for National Institutes of Health (NIH) programs, which we’ll use as an example for the sake of this exercise, and because I worked on one recently. I’m going to use “PA-18-705 SBIR Technology Transfer (R43/R44 Clinical Trial Not Allowed)” program, which has download instructions at Grants.gov. When you download and review the “instructions,” however, you’ll find this complication:

It is critical that applicants follow the SBIR/STTR (B) Instructions in the SF424 (R&R) SBIR/STTR Application Guide (//grants.nih.gov/grants/guide/url_redirect.htm?id=32000)except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts (//grants.nih.gov/grants/guide/)). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced.

Notice that the URLs in the quoted section are incomplete: it’s up the applicant to track down the true SBIR application guide and correct FOA. I did that, but the tricky phrase is “follow the SBIR/STTR (B) Instructions […] except where instructed to do otherwise.” For the particular NIH application we were working on, the FOA and the Application Guide disagreed with each other concerning how the narrative should be structured and what an applicant needed to include in their proposal. So what’s an applicant, or, in this case, a hired-gun grant writer, to do? With some SBIRs, there is no canonical set of questions and responses: there’s the “general” set of questions and the FOA-specific set, with no instructions about how reconcile them.

To solve this conundrum, I decided to develop a hybridized version for the proposal structure: I used the general narrative structuring questions from the application guide, and I tacked on any extra questions that I could discern in the program-specific FOA. The only plausible alternative to this hybridized approach would have been to contact the NIH program officer listed in the FOA. As an experienced grant writer, however, I didn’t reach out, because I know that program officers confronted with issues like this will respond with a version of “That’s an interesting question. Read the FOA.”

The challenge of multiple, conflicting SBIR guidance documents isn’t exclusive to the NIH: we’ve worked on Dept. of Energy (DOE) SBIRs that feature contradictory guides, FOAs/RFPs, and related documents. It takes a lot of double checking and cross checking to try to make sure nothing’s been missed. The real question is why inherently science-based agencies like NIH and DOE are seemingly incapable of producing the same kind of single RFP documents typically used by DHHS, DOL, etc. Also, it’s very odd that we’ve never worked on an SBIR proposal for which the federal agency has provided a budget template in Excel. In the NIH example discussed above, the budget form was in Acrobat, which means I had to model it in Excel. Excel has been the standard for spreadsheets/budgets since the ’80s.

We (obviously) work on grant applications all the time, and yet the SBIR reconciliation process is confusing and difficult even for us professional grant writers. The SBIR narratives, once we understand how to structure them, usually aren’t very challenging for us to write, but getting to the right structure sure is. For someone not used to reading complicated grant documents, and looking at SBIR guidance documents for the first time, the process would be a nightmare. Making SBIRs “easier” with extra, generic application guides that can be unpredictably superseded actually makes the process harder. This is good for our business but bad for science and innovation.

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NIH opioid research grants are here; expect opioid treatment RFPs to come soon

In his review of Dreamland: The True Tale of America’s Opiate Epidemic” and in his post on the “New grant wave for Medication Assisted Treatment (MAT),” Isaac noted that the heroin and prescription drug addiction epidemic crisis is likely to generate new grant programs. Since then, the crisis has in some ways been getting worse, not better, especially in politically sensitive parts of the country. The federal response has so far been slower than we expected, but the NIH just released a trio of research grant RFPs focusing on “Marijuana, Prescription Opioid, or Prescription Benzodiazepine Drug Use Among Older Adults.” Those grants are under the NIH R01, R03, and R21 categories.

The only surprising thing about these RFPs is how long they’ve taken to hit the street. Every time you see a news article or watch a TV exposé about the opioid epidemic, the likelihood of federal action rises. And every time you see such an article or video, you should be thinking about how it will affect your own proposals.

For example, SAMHSA just released a new RFP for a very old program: “Targeted Capacity Expansion-HIV Program: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS (Short Title: TCE-HIV: High Risk Populations).” Someone ought to tell SAMHSA that brevity is a virtue in program titles, but apart from that I’ll note that, if I were writing a TCE-HIV proposal, the needs assessment would be filled with data about opioid use. We have collectively known about the dangers of sharing needles for decades, but the present opioid issue gives new urgency to old problems.

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Why Academics Don’t Always Make Good Social and Human Services Grant Writers

People with advanced degrees and university professors are (presumably) good at lots of things, like publishing the original research they’re trained to produce, but they aren’t always good grant writers—especially for the kinds of social and human service proposals that Seliger + Associates often writes. I think there are lots of reasons for this:

  • Academics often don’t like or respond well to short deadlines. Having a four- to six-week turnaround time simply isn’t enough. Having a one- to two-week turnaround time, which we sometimes do, is even harder. And a lot of people, academics included, don’t have the right stuff.
  • You don’t have to be an expert to write on a subject, but academics are culturally encouraged to make claims only in areas they have studied deeply. This means they often sneer at dilettante journalists, but journalism is actually the field most analogous to grant writing, and sometimes being an expert can actually impede your ability as a grant writer by making you too enmeshed in the area. Reviewers won’t have the same expertise as you, and the assumptions you hold might not be the ones everyone else holds. What you really need to do is tell a story—and experts are often better at making find-grained distinctions of fact or opinion than telling stories. We discuss the problems of experts in National Institute of Health (NIH) Grant Writers: An Endangered Species or Hidden Like Hobbits?. (Note that this paragraph won’t necessarily apply if you’re seeking advanced research grants).
  • Academics love committees and process. Both are lovely in their time and place, but writing a proposal isn’t one of them, and a love of committees sometimes leads to the critical mistake of trying to divide writing tasks.
  • A lot of academics have no idea how social and human services are actually delivered. They know how such services should be delivered in theory, but the gap between theory and practice is wider in practice than in theory. They haven’t read Project NUTRIA: A Study in Project Concept Development or Every Proposal Needs Six Elements: Who, What, Where, When, Why, and How. The Rest is Mere Commentary.
  • Academics are sometimes prone to hand-waving, which I witnessed in my own department’s colloquium and described in Grant Advice is Only as Good as the Knowledge Behind It.
  • The goal is to get the money, not to be right.

This last one is especially significant, and we’ve talked about it before in The Real World and the Proposal World and The Worse it is, the Better it is: Your Grant Story Needs to Get the Money. If your goal is to get the money, you should disregard data that doesn’t support the idea that your service area needs the money and highlights the idea that service area does. You shouldn’t lie, but the judicious selection of facts and ideas to support the narrative you’re trying to develop will help your application.

As mentioned above, grant writing, especially for social and human services, is more than anything else about telling stories. Sometimes stories aren’t entirely factual, or miss an important part of the whole picture, but they’re what proposals (and journalism feature stories) are made of. So if you can get important-sounding opinions from misery professionals but not much about data, use the important-sounding opinions. Sometimes they’re not very far from “research” anyway. Here’s how you get data: take a bunch of opinions, collate them, publish them, and call them data. A lot of peer-reviewed articles basically amount to this. You can spend loads of time searching for research to support your organization’s need and come up with nothing or with weak research. If so, it’s time to roll up your sleeves and massage what you’ve got. A lot of academics can’t, or won’t, do that.

To be sure, I’m confident that there are some academics and professors out there who would make or are lovely grant writers. But we’ve witnessed a sufficient number of failed grant writing attempts by academics to doubt most are good at it. If you have an academic writing social or human service proposals, especially if it’s the academic’s first time doing so, make them read this post.

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National Institute of Health (NIH) grant writers: An endangered species or hidden like Hobbits?

Type “NIH Grant Writers” into Google and look at what you find: pages and pages of “how-to” sheets with no actual grant writers.

That’s not surprising: trying to become a specialist NIH grant writing consultant would be really, really hard because the niche is sufficiently small that one couldn’t easily build a business solely around NIH grants. And the people who could or would want to write solely NIH grants are employed by universities or big hospitals and aren’t available for consulting.

You probably won’t be able to find a specialist in NIH grant writing even if you think you should find one. Isaac addressed this problem in “No Experience, No Problem: Why Writing a Department of Energy (DOE) Proposal Is Not Hard For A Good Grant Writer:” “Looking for qualified grant writers is about the same as looking for unicorns: don’t make a hard problem insolvable by looking for a unicorn with a horn of a certain length or one that has purple spots. Be happy to find one at all.”

He used the same unicorn language in “I Was Right:”

Two of the qualified SGIG [Smart Grid Investment Grant] callers did not “believe” and presumably kept searching in the forest for the perfect, but ephemeral, grant writing “unicorn” I described in my original post. One caller became our sole SGIG client for this funding round. The application process culminated in a finely crafted proposal that went in on the deadline day.

The proposal got funded, even though we’d never written a Smart Grid proposal before—and neither had anyone else. How’d we do it? Through the same means described in “How to Write About Something You Know Nothing About: It’s Easy, Just Imagine a Can Opener,” which explains how an attentive generalist learns to write a proposal for unfamiliar programs (and remember: all programs are unfamiliar when they first appear; this was certainly true for Smart Grid applicants). The same principles apply to all proposals; the trick is finding someone who understands and can implement those principles on a deadline.

Such people are as rare as the ones who know a lot about NIH grant writing. If you created a Venn diagram of the two, you’d probably have almost no overlap. If you were going to set up a business writing NIH proposals, you’d need at least three very unusual skills: able to write, able to hit deadlines, and health knowledge, ideally through getting a PhD or perhaps a research-oriented MD. But that would be really, really time consuming and expensive: MDs don’t come cheap, and even family docs make six figures after residency. The kinds of people capable of being NIH grant specialists are either an endangered species that’s seldom seen or hidden like hobbits in the modern world, who can vanish in a twinkle and apparently aren’t on the Internet.

In short, you’re not going to find them. We explain this fairly regularly to people who call us looking for “experts” and “specialists” in grant writing for particular fields, but they often don’t believe us, despite our seventeen years of experience.

EDIT: We’ve also worked for clients who’ve sat on NIH panels, and many say that, if they can’t figure out what the proposal is about within ten minutes of starting, they don’t even read the rest of it. You may see a blog post on this subject shortly.

Our Experience Trying to Hire Grant Writers

There’s one other reason we’re skeptical that you’ll find many specialized grant writers, let alone general grant writers: we’ve hired a lot of grant writing stringers, and most of them turned out to be not particularly great grant writers.* The best one had no unusual training at all—he was a journalist, which meant he understood the 5Ws and the H and was accustomed to writing against inflexible deadlines. Most thought they could write proposals, but they couldn’t pass the test Isaac describes in Credentials for Grant Writers from the Grant Professionals Certification Institute—If I Only Had A Brain.

The number of people out there who claim they can write against deadlines or pretend they can is vastly larger than the number of people who actually can. If there’s something strange, and it don’t look good, who you gonna call? Ghostbusters! If you’ve trying to understand a RFP, and it don’t look good, you know who to call. Alternately, you could keep searching until the deadline has passed, in which case the probability of you not being funded is 100%.


* This was mostly before my time, however; once I got to college, I tended to write more proposals, and the frustrations of stringers weren’t worth the benefit for Isaac. In addition, I’m mostly inured to his sometimes acerbic commentary by now. Seliger + Associates has not used stringers for well over ten years.