What Do You Do with the “Pink Sheets?”

It has taken you from 6 to 12 months to craft a beautiful piece of work. The application is clear, coherent, comprehensive yet concise, and cutting edge. The figures tell a highly innovative story leading a reader to a definitive conclusion. Now you get a letter with many pages of what you did or did not do, criticisms that cut you to your core competency including your own self worth, how your aims are never going to work. Your application is not going to be funded for you to continue to pursue your ideas, your passion. Now what?

One can define what happens next based loosely on the Kübler-Ross Model, which describes the five discrete stages of grief and tragedy, based on her book, On Death and Dying:

1. Denial: “It can’t be happening.” Not much to discuss here . . . all that clear work, denial is immediate. You had such high expectations when that grant was mailed.

2. Anger: “Why me? It’s not fair.” Again, not surprising. Everybody else seems to be well funded, what is the matter, why could the committee not see how great my application was? They are not really my peers, they are just nobodies . . . .

3. Bargaining: “Just let me live to see my children graduate.” The reality of course is that getting a grant or not is not so much a matter of life and death, and it is not more important than that . . . yet, we all want to be accepted in our own circles and we all would like to succeed. If I only could just get this grant, then all will be well.

4. Depression: “I’m so sad, why bother with anything?” Again, not much surprise here . . . “I am just off to clinical practice (which I am really good at anyway) or off to industry, etc.”

5. Acceptance: “It’s going to be OK.” And this is REALLY true . . . it is going to be OK.

So . . . why is there a problem with funding? It is pretty obvious that there are a lot of good ideas and not much money. In general, there are three buckets of grants. There are those that are the top of the cream, outstanding grants that clearly rise to the top. Then there are those that are just simply poor and that never will be funded for many reasons. The difficulty of course is those grants that fall in the middle. When times are good with lots of money flowing, the funding rate is somewhere in the neighborhood of 30% or more— the outstanding and the excellent grants are being funded and the community is generally fat and happy. When times are lean and the funding rate nears the 10% or lower range, then only selected outstanding grants are being funded and there is a lot of gnashing of teeth.

What to do when you get back your pink sheets? If the comments are enthusiastic and your score is in the range for funding, you can laugh all the way to the bank. Thank all the people that helped you and get to work. Remember, however, that the score is not the only cut off for funding. The priorities of the Institutes are also important. What this means is that occasionally there are instances that a grant has a score that is good enough to be funded but it is not because of what the Institutes decided were their priorities.

What if the summary statement is less than stellar? The first thing to do is to put it away for a couple of days. Unfortunately, bad news is not like wine . . . it will never get any better, but its better not to react immediately to the summary statement. Remember that the summary statement is going to be fairly frank in its language and likely will lack much enthusiasm. After a few days, maybe even a week, re-read the summary statement. Now, if at all possible, try to re-read it emotionally detached. Remember that the study section reviewers are not perfect, yet in general the individual members and the whole group will have some good comments. Remember as well that study sections are inherently conservative. Your review will either be accompanied by a score, which means that it was not triaged, or it could be that it was triaged.

The first statement to look for is “fatally flawed.” If that is in the summary statement and its true, delete that grant from your word processor and walk away. That is one way for the reviewers to let you know that your ideas or at least those proposed will not go forward . . . at least with those reviewers. It is probably better to start again unless the fatal flaw can be easily corrected.

The next step is to read the critique again. You will find that frequently there are insightful and helpful comments that actually do improve your application. The reviewers, in general, really are there to try to help you if they like the idea; even if they do not, they do try to help you improve your grant. Reviewers are not out to get you. They may not necessarily know the details of your field of interest, but most are experienced researchers and they do know whether, for example, there are sufficient patients for significant statistical analyses or whether a particular molecular test or laboratory technique can be applied. They have spent time and effort to help you improve your application.

Once you have re-read the critique, it’s time to get to work. Begin by thanking the reviewers for their efforts and then addressing each of the critiques. Remember that the good news about word processing is that it does what you tell it to do. The bad news is that it does what you tell it to do. There is no excuse for a poor cutting and pasting job, and there is especially no excuse for typos. Copy each critique and below each write the rebuttal. In general, it is like being in the Army…when they tell you to jump; you ask, “how high?” Respond to each critique completely in a POSITIVE manner. While no one expects you to accept factual errors in the critique, it is better not to be combative even though it may make you feel better. Sending petulant, whiny, combative, derogatory comments back to the study section is a sure way to ensure that your score will not improve. If there are factual errors or errors because the reviewers missed the data, re-write it so that it’s clear. Point out factual errors supported by the literature. If there is the need for simple experiments to bolster your data, you should try to provide them in your resubmission, making it clear that you are responsive to the critique. You may know deep down in your heart that some of the comments are nonsense, but unless there are direct data to refute it, it is easier to work around such comments rather than be combative.

As you are reworking the grant, remember to go back to the fundamentals that have been presented by the previous speakers. Find a reviewer in your institution, preferably someone who is well funded. This person could be your mentor or it could be someone that is a good educator. Have this person read the grant. Remember, however, that these individuals are extremely busy. If you give this person the grant to read and its due out the door next week, you can be sure that the level of input that this individual will provide will be limited not only because there was not enough time for a useful review, but if there are areas that could be improved, you will not have enough time to do it. This means that you should have the grant written at least 2 months before the due date to that this person or these persons will have time to read it. It is important to find someone who will be critical. If the only feedback you get is from someone who doesn’t want to hurt your feelings, doesn’t have the time to do a thorough job, or isn’t invested in your success, you lose. If the first criticism you get is from the study section, you have done the equivalent of going on stage without rehearsing. Don’t do it.

You are writing to the reviewer . . . you want him or her to understand your passion for research and that you have the capability to carry out the aims. Sometimes it may be useful to read the whole grant out loud so that you can see which sections do not flow well. If there are areas that are fuzzy to you, you can be sure they will be fuzzy to the reviewer.

Many of your first grant applications will be “mentored awards.” This is a pretty exact term. The instructions that come with these grants are not generalities that you can pick and choose. There are specific requirements. Be sure to read through these instructions completely and follow them to the letter. Remember that none of the reviewers really know you yet. Aspects of the application that can really hurt the individual are things like not paying attention to details. The implication is that if you do not pay attention to the details in the written application, you are not likely to pay attention to details in your research either. Lack of a mentor’s letter or inclusion of a lukewarm letter can also be a major problem. This is an area that is up to you to push. There are specific requirements that the mentor should state in the letter besides just how great of a person you are. Be sure that the letter that is written for you includes the specific points that have been asked for. Your mentor should be seeing your grant at several stages in its preparation. If he/she is not, you are not likely to do well. Take advantage of critical feedback from people who are committed to you. If your mentor does not give you such feedback, you need another mentor—either a different person, or an additional person. The biggest deficit in the K award applications is failure of mentor input, and this is a two-way street. It is very obvious in these applications when the grant has not been reviewed before submission. Study section members don’t know whether the mentor or the investigator did not do his/her job, but if you want a fatal flaw, this is it. The mentored awards are intended to encourage, but cannot force, these interactions. If you don’t do it, you lose.

Remember that there is great joy in being funded. Where else or in what other job can you get money like this to pursue your own ideas, in essence to play with someone else’s money for solving important problems, especially those that can have a direct benefit for patients? The road is not easy, but the rewards for those who continue to toil are great. If you have passion in continuing with research, I am sure you will succeed. I leave you with quotes from two highly successful individuals; each had a great share of frustrations and failures . . . .