INTERVIEW WITH CMB OPEN COMPETITION PROPOSAL REVIEWER
By Donglan Zhang
The interviewee is an anonymous proposal reviewer for China Medical Board (CMB) 2012 Open Competition (OC).
Donglan Zhang is a PhD candidate in the Department of Health Policy and Management at University of California, Los Angeles.
Donglan: What is your overall assessment of the proposals submitted to CMB 2012 OC? Do you have any suggestions for applicants in light of the comparison between this year (2012)’s OC proposals and those submitted in earlier years or proposals submitted for other funding opportunities?
Interviewee: The OC proposals share the following common features: 1) high policy relevance; 2) lack of familiarity with the existing evidence and theory; 3) room for improvement in terms of research method; 4) excellent teamwork and collaboration. This is the first time I am reviewing for the competition, so I cannot speak about comparison over time.
受访者：公开竞标项目的申请标书有以下共同特点：1) 与政策高度相关; 2) 不够熟悉研究领域内现有的证据和理论; 3) 研究方法仍有待加强; 4) 具有相当程度的团队合作。这是我第一年做评审，所以尚没有比较。
Donglan: What are the areas that need improvement of the proposals? Can you elaborate on one or two areas that you think are the most critical?
Interviewee: Many applicants have not had a thorough survey of the field. They show a lack of knowledge about the research and practice within and outside of China in their areas of research. This is even more critical than the deficiency in research method.
Donglan: We really appreciate and admire your effort in improving the quality of health research in China. Do you have any suggestions for junior researchers who plan on submitting proposals for CMB funding?
Interviewee: I have two suggestions. The first is to form collaborative relationship with senior researchers. By “senior” I mean those having substantial international research/publication experience. The second is to collaborate with health practitioners. These are professionals who are experienced in clinical/hospital management practice within and outside of China.
Donglan: From your perspective, could you please recommend some future research directions or identify existing gaps in health research in China?
Interviewee: Qualitative study is a huge gap in health research in China. Case study, participatory observation, cognitive interview, and focus groups are all very important tools and methods in formulating hypotheses.
Donglan: Do you have any words of wisdom for junior scholars in Health Policy and Systems Science (HPSS)? Do you have any suggestions as to how CHPAMS may contribute to the capacity building of HPSS research in China?
Interviewee: Matching overseas scholars with Mainland Chinese scholars might be a good strategy. CHPAMS could facilitate the process of matching overseas mentors with young scholars in China. Many Chinese scholars are able to obtain financial support for visiting scholar programs with international institutions. However, there is no good mechanism to pair them up with the appropriate mentors through the program. Therefore they cannot make full use of their time while studying abroad.
INTERVIEW WITH DR. YU FANG (ASSOCIATE PROFESSOR, XI’AN JIAOTONG UNIVERSITY)
By Kun Zhang Ph.D.
Dr. Yu Fang is an associate professor in the Department of Pharmacy Administration at the School of Medicine, Xi’an Jiaotong University. Dr. Fang’s research interests focus on assessing the accessibility of essential prescription drugs in western China and evaluating outcomes of pharmaceutical care for patients with hypertension. Dr. Fang has published multiple peer-reviewed journal articles and book chapters.
Kun Zhang is a Prevention Effectiveness Fellow at the Centers for Disease Control and Prevention
Kun: What aspects of the CMB Open Competition (OC) grant you find the most appealing?
Dr. Fang: What appeals to me the most is the purpose and theme of the CMB OC, which is to improve health policy and systems sciences (HPSS) research capacity in China through supporting researchers in medicine and public health across China. Second, CMB OC emphasizes emerging health challenges and the new healthcare reform in China, and it is willing to fund research in these areas to ensure that people in China have equitable access to healthcare. Third, CMBOC provides young researchers in China a great platform for international and domestic exchange.
Kun: Are there any lessons learned from participating in the CMB OC?
Dr. Fang: The application for CMB Open Competition grant led to many new ideas for me when searching for research topics and carrying out HPSS studies. Moreover, in the second round of the review process, the reviewers provided constructive comments on study design, data collection, feasibility of the proposal, and the budget planning. These comments are extremely helpful to my future research and grant writing. I truly appreciate the effort and contribution of all the reviewers.
Kun: As an expert in pharmaceutical policy research, what do you think are the major causes for the high price of pharmaceutical products in China?
Dr. Fang: In my opinion, the long-standing public hospitals' reliance on drug sales to generate revenue is the main reason of the high price of pharmaceutical products in China. In 2009, national health care expenditure in China totaled $240 billion, about 5% of China’s gross domestic product (GDP). Spending on drugs accounted for more than 40% of total expenditure, which is one of the highest in the world. The high pharmaceutical expenditure is associated with both high retail prices of drugs and high utilization, some of which are irrational and unnecessary. Furthermore, both price and utilization factors are deeply associated with policies including overall health sector regulation, health care financing policies, and pricing policies. Recognizing the major causes for the disproportionately high pharmaceutical expenditure, the new round of health care reform particularly emphasized the establishment of National Essential Medicines System (NEMS), and the implementation of public hospital reform and promoting rational use of medications.
Kun: What do you think are the pros and cons of establishing a National Essential Medicines system by the central government?
Dr. Fang: According to the WHO Framework for Action, “access to health care including essential medicines is part of the fulfillment of the fundamental right to health. All countries are obligated to work towards the fulfillment of equitable access to health care services and commodities, including essential medicines necessary for the prevention and treatment of prevalent diseases. Appropriate policies and action plans need to be put in place to achieve this aim". In response, as one of the top five priorities of the Chinese government's systematic plan announced in 2009 aiming to achieve universal access to healthcare by 2020, the establishment of a NEMS to meet basic needs for treatment and prevention and ensure drug safety, quality, and supply was particularly emphasized. I am pretty optimistic that by improving access to existing essential medicines in China, more and more people will share the benefits of the healthcare reform. Meanwhile, it is urgent to generate evidence about the impact of the NEMS on access to and affordability of medicines, as well as to support the central government’s implementation of sound pharmaceutical policies.
INTERVIEW WITH DR. JIN YAN (PROFESSOR, CENTRAL SOUTH UNIVERSITY)
By Kun Zhang, Ph.D.
Dr. Jin Yan is a Professor and Deputy Director of the Department of Nursing at the 3rd Xiangya Hospital, Central South University in China. Dr. Yan’s research interests focus on care coordination between hospitals and communities for patients with chronic obstructive pulmonary disease (COPD) and care and education for children with HIV/AIDS in China. Dr. Yan has published multiple peer-reviewed journal articles.
Kun Zhang is a Prevention Effectiveness Fellow at the Centers for Disease Control and Prevention.
Kun: What aspects of the CMB Open Competition (OC) grant are the most appealing to you?
Dr. Yan: It is the theme of the CMB OC, which is to promote health policy and system sciences (HPSS) research in China through selecting and supporting researchers in this area that attracts me the most.
Kun: What aspects of your background and research experience do you think helped you get funded?
Dr. Yan: I have to say that the training of CMB-991 in 2011 benefited me a lot. In addition, I believe my doctoral training and research in epidemiology and statistics helped me. Lastly, my visit and study in the Chinese University of Hong Kong in 2011 improved my writing in English which is also crucial for applying the CMB OC grant.
Kun: In your CMB OC research, what measures did you use to ensure the validity of randomization?
Dr. Yan: In addition to our own work and effort, we have professional consulting company in statistics and research design to ensure the validity of randomization.
Kun: You mentioned that reform in hospital outreach is one of the focus areas in China’s public hospital reform since 2009. What is the impact of the reform so far? What else do you think should be done to improve hospital outreach intervention?
Dr. Yan: The reform is not sufficient so far. More reform is needed on the public hospital payment policy and delivery system. I think the next focus should on compensating public hospitals for community intervention. Hospital community outreach intervention would be improved if payments to public hospitals cover the cost of the intervention.
Kun: As you pointed out, air pollution and smoking are both important risk factors for COPD in China. What would be the impact of these factors on incidence of COPD in the near future given the deterioration in air pollution and expanding smoking population in China?
Dr. Yan: I anticipate higher incidence of COPD if the air pollution in China continues to deteriorate. This will likely to be a heavy burden to the healthcare system in China in the near future. More research is needed to quantify the impact of air pollution.
INTERVIEW WITH DR. WENJIE GONG (SENIOR LECTURER, CENTRAL SOUTH UNIVERSITY)
By Rui Li, Ph.D.
Dr. Wenjie Gong is a senior lecturer in the School of Public Health at Central South University. As a clinician-turned public health researcher with reproductive medicine and gynecology background, Dr. Gong's research interests focus on women's health, especially in reproductive health and mental health.
Rui Li is a Senior Service Fellow at the US Centers for Disease Control and Prevention.
Rui: Could you please introduce yourself, your team, and your proposed project?
Dr. Gong: I have a very diverse background. After I received my Bachelor of Medicine degree in clinical medicine, I went to work in the rural area for one year. For my Master’s degree, I studied genetics with a focus on women’s reproductive health. Afterwards, I worked as an obstetrician at a tertiary hospital for 2 years. In 2008 I became a Ph.D. student in social medicine and started to teach in the School of Public Health. Currently I am a lecturer in the Department of Adolescents and Women’s Health. The diverse working experience and the broad educational background helped me to be open-minded and interdisciplinary. At the same time, I had to learn many new things. Fortunately I work in a great academic team and they have helped me substantially with professional development. In two years, our team, led by Professor Shuiyuan Xiao, has received a CMB CP grant and three CMB OC grants. These achievements are attributed not only to the team members’ hard work, but also to the team members’ experience and scientific training accumulated over time.
My OC project is based in Liuyang, with which our team has a long-term collaborative relationship. My research design has also benefited tremendously from the deep knowledge of the operations of local mental health centers. The main purpose of our study is to explore an effective model for the rural area to address mental health problems. We aim to train the village doctors as a supplement to the “686” project, an ongoing government sponsored program focusing on managing severe mental disease, to effectively manage the bi-polar patients in the rural areas.
Rui: Have you applied for any internationally funded projects before? How do you assess the selection process? What you have learned in this application process that might be useful for your grant-writing?
Dr. Gong: Before applying for the 2012 OC grant, I did not have any experience applying for international grant as a PI. However, I have participated in the application and setting-up of several past CMB projects. Compared with the National Natural Science Foundation grant application, the OC grant application process is more focused on the significance and the feasibility of the project, instead of applicants’ background and experience. However the process was very rigorous and it was an extended process. In addition to the content of the project, it is a test of the perseverance and faith of the applicants. It is important to be confident while recognizing the weakness in my application and working hard to address them. Especially in responding to the review comments, it is critical to realize that no PI could ever be the expert in everything from research design to data analysis and to economic evaluation. In order to succeed in the grant application one needs to find support from other experts that addresses precisely the problem at hand.
Rui: How did you choose the topic?
Dr. Gong: My experience of working in countryside got me interested in rural health. The long-term collaboration between our team and the Liuyang mental health centers helped me understand the role of village doctors in mental health. I also came to understand the issues and needs in implementing the 686 Project. Before the application, I was in charge of the baseline survey for the mental health patients in Liuyang district. The data showed that the proportion of schizophrenic patients who received comprehensive mental health treatment was quite low. So I chose this topic based on the above reasons.
Rui: What kind of training/guidance/support do you hope the CMB can provide for the applicants in the future?
Dr. Gong: It might not be realistic to expect CMB to provide centralized training for all applicants on how to prepare for the application as 991 projects did. However, if CMB can provide the full abstracts of funded projects in the past or even 1 to 2 sample grant applications, that will be very helpful for the applicants in terms of understanding the requirements of the OC project and minimizing the confusion in the application process.
Rui: What is your most memorable experience in applying for this OC grant?
Dr. Gong: Although not sure if I am the least experienced among all awardees of the OC history, I am certainly the only lecturer among all PIs who have received OC funding at Central South University. This is just to make the point that all junior faculties should feel encouraged to participate in such competitions. Since I am still a junior faculty, I did not have much pressure when I applied for the OC grant. However, even failure appeared likely in the eyes of others, I had to do my best when preparing my application. Because the OC grant application was quite an extended process, it was very stressful for the applicants. The further along you are in the process, the more hope you have, but at the same time, the more stressed you become. It was very important to balance the expectation and the stress.
In the last round, CMB selected 13 applications, but did not provide the ranking of the applications nor the number of the applications that would be awarded the grant. The project officers e-mailed several applicants who were “on the margin”. I was one of them. To many applicants, it was perhaps crueler to fail during the last stage than at the beginning. However for me, I focused more on the process rather than the outcome. Although being prepared for the failure, I decided to take the slim odds seriously and spent whole week preparing my responses. At the same time I received full support from my team. We had a group discussion on the review comments. Professor Xiao Shuiyuan and Prof. Zhou Liang provided me with many constructive comments. I prepare very detailed responses to each review comments. For example, when the feasibility of the intervention was challenged, I provided a number of references on the success of similar interventions in the similar population targeted at similar diseases, instead of just putting down “we can try it” or “it should work”. One particular experience I want to emphasize is the response to the comment of adding a health economist to the team. As a medical doctor without any health economics training, I am not equipped to respond to the economic evaluation questions in a short period of time. However I could look for a health economist to join the team. I searched in the literature, asked for reference, sent e-mails to experts, and explained my project on the phone. On the last day before the deadline I secured the support from a U.S. based health economist. Although I was not sure how much of the improvement in my project scoring can be attributed to these efforts, I would like to share my experience with everyone. I hope you would benefit from my experience and succeed in your future career.