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All the details about OMG MY FUNDED GRANT.
Q. How much money is it, and who's paying?
A. I'm being funded by the U.S. National Institutes of Health. NIH put out a call for research proposals addressing "clinical decision making in life-threatening illness," and I responded with a proposal to study how people with HIV make decisions about starting anti-HIV medicines.
I applied under a grant mechanism called "R21," which is designed to support exploratory research aimed in novel directions. The big advantage of an R21 for someone at my career stage is that you're not expected to have tons of pilot data. The R21 is for compiling tons of pilot data, which you then use to justify a larger grant next time.
R21s provide two years of funding. NIH is going to be sending me $125,000 for direct costs in the first year and $100,000 in the second year. ("Direct costs" means money spent directly on research. "Indirect costs" are when your university tacks on 50% extra for grant administration, facilities, et cetera.) The direct costs will cover 50% of my salary and benefits, 50% salary for a research assistant, 5 or 10% of Lydia's salary (I forget) as my "senior advisor," compensation for research participants, miscellaneous supplies, some computers (I think we asked for a desktop for me, and one laptop each for me and my assistant), and travel (two trips to North American scientific conferences for me and one for my assistant).
Q. What are you actually studying?
A. "Cognitive biases and interpretive schemas in antiretroviral therapy decision-making."
See, there's this goofy idea in medical-decisions research that people make decisions about which treatments or health behaviors to adopt by collecting impartial information about benefits and costs and weighing them in a rational manner. If the benefits outweigh the costs, they agree to the treatment.
I think that bears no resemblance to how many people make medical decisions. I think that people tend to filter incoming medical information through a series of mental frameworks that govern their interpretation of what the world is like and how it works. Depending on the nature of those filters, they may reflect incoming information accurately, or they may act like powerful distortion lenses which twist or bias the information beyond recognition. Medical decisions may then be based on a warped accounting of costs and benefits.
For example, if part of your mental framework for understanding HIV is the belief that HIV originated as part of a U.S. government conspiracy to eliminate undesirables (this is an extremely common belief among African-Americans in the U.S.), that framework may well bias your opinion of federally-approved and state-funded treatments recommended by the doctor you're seeing at a public health clinic. Or, for a different example, if you have a basic conviction that "nothing good ever happens to me - my life is hopeless," you may pay little heed to your doctor's glowing picture of medication benefits, and focus instead on the potential for severe side effects.
I'm going to be studying whether and how these cognitive biases and distorted reasoning processes affect HIV-positive people's decisions to accept or reject an offer of antiretroviral therapy.
What makes this study "novel," in NIH terms:
(1) Oddly enough, no one's ever done a rigorous study of why some people refuse ART. People have done open-ended interviews, but not quantitative research.
(2) "Conspiracy theories" about HIV have been studied in the general population and linked to health behaviors, but they haven't been studied among people with HIV. On the one hand, you'd expect those people to be better educated about HIV. On the other hand, you'd expect them to be more open to explanations that none of this is their fault. It's an interesting question.
(3) I'm applying cognitive theory (as in, the theoretical foundation of cognitive-behavioral therapy for mental illnesses) to medical decision-making in a non-psychiatric population. Other people have certainly applied cognitive principles in working with medical patients, but typically only those who are referred for "adjustment problems" or similar - not in medical patients considered generally. So this is a novel application of theory to problem.
Q. What will this mean for your career?
A. It's hard to overstate how important this is for my career. This is a big deal. The ability to attract federal research funding is perhaps the single most important quality an academic scientist can have. True, this is only a small grant - but then, I'm a new junior faculty member. Any NIH funding is prestigious, especially in this era of shrinking federal research dollars.
What makes this different from all the research projects I've worked on before is that I am the Principal Investigator. This is my funding, not anyone else's. I'm solely responsible to the U.S. government for the financial and scientific conduct of the study. I'll be making all of the decisions about how the study is run and how the money is spent. That means that the lion's share of the credit will go to me as well. I've written big portions of Lydia's grants, but at the end of the day she's the PI and the credit and control are hers. In this study? They'll be mine.
This grant will make it much easier to change jobs if I want to. And unless I mess things up, it's designed to smooth the way for my next grant. The whole idea of an R21 is that it's supposed to allow me to collect data which I can then use to support my future requests for research money. In this case, for example, the logical progression would be that I'd use the data from this grant to support a much larger research proposal in which I outline a plan for improving medical decision-making by changing this kind of irrational or biased reasoning.
So this is a Big Deal for my academic career. But also: I think this is an important project which has the potential to make valuable contributions to science. I think this is research that Should Be Done. I am so excited to have the opportunity to make that happen.
A. I'm being funded by the U.S. National Institutes of Health. NIH put out a call for research proposals addressing "clinical decision making in life-threatening illness," and I responded with a proposal to study how people with HIV make decisions about starting anti-HIV medicines.
I applied under a grant mechanism called "R21," which is designed to support exploratory research aimed in novel directions. The big advantage of an R21 for someone at my career stage is that you're not expected to have tons of pilot data. The R21 is for compiling tons of pilot data, which you then use to justify a larger grant next time.
R21s provide two years of funding. NIH is going to be sending me $125,000 for direct costs in the first year and $100,000 in the second year. ("Direct costs" means money spent directly on research. "Indirect costs" are when your university tacks on 50% extra for grant administration, facilities, et cetera.) The direct costs will cover 50% of my salary and benefits, 50% salary for a research assistant, 5 or 10% of Lydia's salary (I forget) as my "senior advisor," compensation for research participants, miscellaneous supplies, some computers (I think we asked for a desktop for me, and one laptop each for me and my assistant), and travel (two trips to North American scientific conferences for me and one for my assistant).
Q. What are you actually studying?
A. "Cognitive biases and interpretive schemas in antiretroviral therapy decision-making."
See, there's this goofy idea in medical-decisions research that people make decisions about which treatments or health behaviors to adopt by collecting impartial information about benefits and costs and weighing them in a rational manner. If the benefits outweigh the costs, they agree to the treatment.
I think that bears no resemblance to how many people make medical decisions. I think that people tend to filter incoming medical information through a series of mental frameworks that govern their interpretation of what the world is like and how it works. Depending on the nature of those filters, they may reflect incoming information accurately, or they may act like powerful distortion lenses which twist or bias the information beyond recognition. Medical decisions may then be based on a warped accounting of costs and benefits.
For example, if part of your mental framework for understanding HIV is the belief that HIV originated as part of a U.S. government conspiracy to eliminate undesirables (this is an extremely common belief among African-Americans in the U.S.), that framework may well bias your opinion of federally-approved and state-funded treatments recommended by the doctor you're seeing at a public health clinic. Or, for a different example, if you have a basic conviction that "nothing good ever happens to me - my life is hopeless," you may pay little heed to your doctor's glowing picture of medication benefits, and focus instead on the potential for severe side effects.
I'm going to be studying whether and how these cognitive biases and distorted reasoning processes affect HIV-positive people's decisions to accept or reject an offer of antiretroviral therapy.
What makes this study "novel," in NIH terms:
(1) Oddly enough, no one's ever done a rigorous study of why some people refuse ART. People have done open-ended interviews, but not quantitative research.
(2) "Conspiracy theories" about HIV have been studied in the general population and linked to health behaviors, but they haven't been studied among people with HIV. On the one hand, you'd expect those people to be better educated about HIV. On the other hand, you'd expect them to be more open to explanations that none of this is their fault. It's an interesting question.
(3) I'm applying cognitive theory (as in, the theoretical foundation of cognitive-behavioral therapy for mental illnesses) to medical decision-making in a non-psychiatric population. Other people have certainly applied cognitive principles in working with medical patients, but typically only those who are referred for "adjustment problems" or similar - not in medical patients considered generally. So this is a novel application of theory to problem.
Q. What will this mean for your career?
A. It's hard to overstate how important this is for my career. This is a big deal. The ability to attract federal research funding is perhaps the single most important quality an academic scientist can have. True, this is only a small grant - but then, I'm a new junior faculty member. Any NIH funding is prestigious, especially in this era of shrinking federal research dollars.
What makes this different from all the research projects I've worked on before is that I am the Principal Investigator. This is my funding, not anyone else's. I'm solely responsible to the U.S. government for the financial and scientific conduct of the study. I'll be making all of the decisions about how the study is run and how the money is spent. That means that the lion's share of the credit will go to me as well. I've written big portions of Lydia's grants, but at the end of the day she's the PI and the credit and control are hers. In this study? They'll be mine.
This grant will make it much easier to change jobs if I want to. And unless I mess things up, it's designed to smooth the way for my next grant. The whole idea of an R21 is that it's supposed to allow me to collect data which I can then use to support my future requests for research money. In this case, for example, the logical progression would be that I'd use the data from this grant to support a much larger research proposal in which I outline a plan for improving medical decision-making by changing this kind of irrational or biased reasoning.
So this is a Big Deal for my academic career. But also: I think this is an important project which has the potential to make valuable contributions to science. I think this is research that Should Be Done. I am so excited to have the opportunity to make that happen.
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(My sister, as I think I've mentioned, is a library professor specialising in medical informatics, and she's done a lot of work on how people look for medical information, so it's also fascinating comparing some of the same basic issues from two different disciplines.)
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Congrats!
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I am startled that the medical-decisions researchers are still working with a pure rational-actor model, the sort of thing that economists used to present, despite the clear evidence that (for an easy example) people would buy insurance because a baseball player or a cartoon dog was selling it. Even if they aren't taking the belief in conspiracy theories seriously, there's lots of choosing a doctor because a relative recommends her, and the drug companies are obviously getting something for their ad dollars.
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This is really meaningful work.
I'm so glad you got the funding to do it. I know you put a lot of time, energy, and Focused Intent into getting this together, and the grant is well-deserved.
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Huge Congratulations!!
Wow!
Nice bit of "shared joy" there, to brighten up my day just by knowing you'd gotten this.
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all the best.
xx, e
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Thank you so much for telling us exactly what it's for and the like.
N.
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I remember a class on medical anthropology during my MA which addressed mental models of medicine and how clearly it impacts decision-making in seeking treatment.
There was a fascinating study done on the mothers of sick children in Mali, West Africa, trying to determine when they go seek professional medical help, vs use home remedies or use "healing women" (grandmothers and the like).
Their model of illness had three main categories - fire illnesses (fever) were considered serious, water illnesses (diarrhea) were not, and wind illnesses (respiratory infections) were somewhere in the middle. Access to cash to pay for the doctor/travel/drugs combined with their assessment of the seriousness of the illness were a main causative reasons for the type of care they sought for their child.
If the illness was considered serious (and all fevers were serious), they would generally have to ask the father of the child (or other male with cash) for money for the clinic - otherwise, mothers tended to avoid the hassle and just go with local women healers (who they could barter with instead) or just use a home remedy.
Course, there were also gender considerations, birth order considerations, age considerations, etc (i.e. older male first borns tended to get more medical attention than baby third daughters - even in a society where girls are extremely valued).
I am really looking forward to hearing more about your research. It should be fascinating the things you discover.
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Go Detectivedoctorinvestigatorlady!
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