National Advisory Council on Alcohol Abuse and Alcoholism

Summary of the 115th Meeting

May 24, 2007

The National Advisory Council on Alcohol Abuse and Alcoholism convened for its 115th meeting at 5:30 p.m. on May 23, 2007, at the Fishers Lane Conference Center in Rockville, Maryland, in a closed session, and again in open session at 9:00 a.m. on May 24. Dr. Ting-Kai Li, Director of the National Institute on Alcohol Abuse and Alcoholism, presided over the closed and open sessions. Dr. Tina Vanderveen presided over the review of grant applications in the closed session on May 23. In accordance with the provisions of Sections 552b(C)(6), Title 5, U.S.C. and 10(d) of Public Law 92-463, the meeting on May 23, 2007, was closed to the public for the review, discussion, and evaluation of individual applications for Federal grant-in-aid funds.

Council Members Present:

Michael E. Charness, Ph.D.
Cheryl J. Cherpitel, M.P.H., Dr.P.H.
Arthur T. Dean, Major General, U.S. Army, Retired
Cindy L. Ehlers, Ph.D.
R. Adron Harris, Ph.D.
Victor M. Hesselbrock, Ph.D.
Joannes B. Hoek, Ph.D.
Mack C. Mitchell, M.D.
Peter M. Monti, Ph.D.
James W. Payne, J.D.
Kenneth J. Sher, Ph.D.
Alan C. Swann, M.D.
Boris T. Tabakoff, Ph.D.
Hidekazu Tsukamoto, DVM, Ph.D.

Chairperson: Ting-Kai Li, M.D.

Executive Secretary: Abraham Bautista, Ph.D.

Senior Staff:

Linda Chezem, J.D.,Vivian B. Faden, Ph.D., Ralph W. Hingson, Sc.D., M.P.H., Robin I. Kawazoe, Howard Moss, M.D., Antonio Noronha, Ph.D., Tina Vanderveen, Ph.D., Kenneth R. Warren, Ph.D.,Samir Zakhari, Ph.D.

Other Attendees on May 24, 2007:

Approximately 45 additional observers attended the open session, including representatives from constituency groups, liaison organizations, NIAAA staff, and members of the general public.

Call to Order of the Closed Session, May 23, 2007

Dr. Ting-Kai Li called the closed session of the 115th meeting of the National Advisory Council to order at 5:30 p.m. on Wednesday, May 23, 2007. Dr. Tina Vanderveen presided for the consideration of grant applications by Council Members. She reviewed procedures and reminded Council members of regulations pertaining to conflict of interest and confidentiality. Members absented themselves from the discussion and evaluation of applications from their own institutions and in situations involving any real, apparent, or potential conflict of interest. MERIT award nominations were presented by Dr. Kenneth Warren. The closed session adjourned at 8:00 p.m.

Call to Order of the Open Session and Introductions, May 24, 2007

Dr. Li called the open session to order on May 24, 2007 at 9:05 a.m. and welcomed participants. Members of the Council, NIAAA staff, and audience members introduced themselves.

Director's Report/Special Announcements

Referring to the published "Director's Report," Dr. Li highlighted the following Institute activities:

• Legislation: Bills have been introduced in Congress to change the name of the Institute to the National Institute on Alcohol Disorders and Health to reflect the Institute's current mission to study alcohol use and its influence on health across the lifespan. Dr. Li presented the NIAAA FY 2008 President's budget request to the House Labor, HHS and Education Subcommittee on March 1, 2007 and to the Senate Appropriations Subcommittee on March 26, 2007. On December 26, 2006, the President signed into law the Sober Truth on Preventing Underage Drinking (STOP Underage Drinking Act) addressing activities to curb underage drinking.

• Budget: The FY 2007 appropriation for NIAAA is $436.5 million, an increase of $0.5 million and 0.1 percent over the President's budget request. Keith Lamirande presented details to the Council. The 2007 Joint Resolution directly funded the NIH Roadmap. Roadmap IC contributions were returned to the ICs and redistributed to other extramural mechanisms ($5.231 million for NIAAA). This additional funding increased the number of NIAAA grants from 202 to 210 this year. With 746 applications in 2007, this leads to an estimated 28% success rate. To further support researchers, in 2007, NIH created the NIH Director's Bridge Awards for investigators whose applications just missed the funding pay line. NIAAA can nominate such investigators for this award which is funded in its first year by NIH. Two Bridge awards for NIAAA have been approved; the goal is four to six to be approved in 2007. Pathway to Independence Awards is a NIH initiative that began in 2006 to support new investigators; they start as a K99 for two years and can then transition to a Research Project Grant (R00) mechanism for three years. Two have been funded by NIAAA, which is committed to funding three in 2007 and six in 2008. Also for new investigators, NIH has committed to funding 1,500 first-time R01 investigators in 2007. NIAAA is committed to funding 27, extending the pay line if necessary, to do so.

  Dr. Li reported that the Centers for Medicare and Medicaid Services (CMS) has added new codes to facilitate provision and reimbursement for alcohol and drug screening and brief interventions.

• Director's activities: Dr. Li addressed the Asian American and Pacific Islander Scientific Conference and the National Advisory Council on Minority Health and Health Disparities in February 2007; the Alcohol Research Center Directors meeting in March 2007; and the Institute of Psychiatric Research and the American College of Neuropsychopharmacology in May 2007. Dr. Li and NIAAA colleagues briefed Congressman Patrick Kennedy on the origins and treatment of addiction in February 2007, and met with representatives of the Chinese Academy of Science and attended a memorial for Dr. Henri Begleiter in April 2007.

• NIAAA staff and organizational changes: Ms. Robin Kawazoe becomes Associate Director for Administration on May 27, 2007. Dr. Bridget Grant, chief of the Laboratory of Epidemiology and Biometry, will receive the Jellinek Memorial Award, in July 2007. Dr. Peter Delany received The Excellence in Healthcare Leadership Award from the Health Service Officers Professional Advisory Group and Dr. Angela Martinelli received the 2007 RADM O. Marie Henry Publication Award for Clinical Practice by the Nurse Professional Advisory Committee of the U.S. Public Health Service Commissioned Corps. Drs. Beata Buzas, Ivana Grakalic, John Matochik, and Bob Ward and Joanna Yoon have joined NIAAA. Mr. Matt Packard resumed his position as Chief of the NIAAA Contracts Management Branch after military duty; and Dr. Kenneth Warren has been named Acting Director of the Office of Science Policy and Communications.

• Research priority emphasis and core support teams: The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking was issued on March 6, 2007. Drs. Vivian Faden and Patricia Powell served as NIAAA's representatives to the Office of the Surgeon General and as senior scientific editors during development of the document. They, Dr. Li, and NIAAA colleagues participated in a legislative briefing about the Call to Action on March 5 and briefings for constituent groups and the press on March 6. NIAAA printed 15,000 copies of the Call to Action and 10,000 copies of three accompanying "People's Pieces" for families, communities, and educators

NIAAA research programs:

• NIAAA will participate in the Epigenetics Roadmap initiative that will be a major initiative in 2008.
• The Extramural Project Review Branch has conducted 10 reverse site visits/reviews for Alcohol Research Centers and the Consortium on Fetal Alcohol Spectrum Disorder, organized several special emphasis panels in response to program announcements on brain development, medications development, epigenetics, endophenotypes, NeuroAIDS and alcohol. Twenty P20 applications were reviewed by seven separate panels based on research themes.
• NIAAA has received or is expecting (based on letters of intent) 77 applications in response to 14 Requests for Applications for 2007.
• NIAAA-supported research was published in a wide array of journals, including the Archives of General Psychiatry, Biological Psychiatry, Alcoholism: Clinical and Experimental Research, Behavioral Neuroscience, and the American Journal of Public Health.

Scientific meetings: NIAAA staff gave presentations at numerous scientific meetings, including the American Society of Addiction Medicine, the American Psychiatric Association, the University of Connecticut, McGill University, and others.

Outreach:

• Leadership to Keep Children Alcohol Free, among whose leaders is former Council member Hope Taft, is now an independent non-profit foundation. It assisted with the development of the Surgeon General's Call to Action. The Leadership received the R. Brinkley Smithers Award from the Christopher D. Smithers Foundation this year in recognition of its efforts on underage drinking.
• NIAAA staff participated in the Community Anti-Drug Coalitions' National Leadership Forum in February 2007, and in a SAMHSA/CSAP Community Prevention Day on February 12, 2007 that focused on underage drinking.
• NIAAA co-sponsored the Fordham University Workshop on Underage Drinking in May 2007 that focused on college-age drinking and how to implement recommendations from the New York City Council's "Nightlife Safety Report."
• The HBO television program, Addiction, featuring NIAAA's Mark Willenbring, aired on March 15, 2007, and was also disseminated by DVD, book, podcast and video streams. It has been very popular and received additional coverage on major television programs.

NIAAA multi-media products: NIAAA has disseminated 67,000 copies of the updated Helping Patients Who Drink Too Much: A Clinician's Guide, since the beginning of 2007 in response to requests and through partnerships with professional associations, a direct mailing to deans of nursing schools, and an e-announcement to 230 organizations.

• Upcoming events: These include an NIAAA symposium on Social Neuroscience and Mechanisms of Behavior Change on May 24-27 during the Annual Convention for Psychological Science on May 24-27 and the Annual Scientific Meeting of the Research Society on Alcoholism in Chicago on July 7-12.

Discussion: Dr. Tabakoff suggested direct mailing the Clinician's Guide to medical students; Dr. Li stated that NIAAA would consider how to do so, considering cost. Dr. Monti said that Dr. David Lewis in his department has a program to educate medical students about alcohol and may be able to initiate such an outreach effort.

Extramural Advisory Board (EAB) Report

Dr. Fulton Crews reported on a meeting of the EAB on February 6-7, 2007 on fetal alcohol spectrum disorders. The three major themes around which recommendations were developed include description and diagnosis, etiology and neural plasticity, and intervention and treatment. In addition to the EAB, attendees included NIAAA staff, some Council members, and experts in the field.

The final recommendations of the EAB are:

1. To define the full range of FASD/prenatal alcohol phenotypes and endophenotypes across the lifespan using advanced methods, technologies and applications-integrative biology/systems biology and database approaches.
2. Develop and validate biomarkers to assess the exposure and insult to the mother and fetus.
3. Conduct analyses of pre- and postnatal nutritional, genetic, epigenetic and environmental factors to determine risk or protective factors and co-morbidities (e.g., diabetes, tobacco and other drugs) that may alter susceptibility and natural history of fetal alcohol spectrum disorders.
4. Study the safety and efficacy of interventions (e.g., nutritional, pharmacological, neurobehavioral., and environmental) during periconceptional, pregnancy, and lactational periods.
5. Elucidate biological mechanisms that contribute to ethanol teratogenesis in a range of experimental models and in humans, including mechanistic links to biomarkers and treatment.

In all of these, NIAAA should explore partnerships with other Institutes, federal agencies, other countries, and health care systems; engage a range of disciplines to address the neurodevelopmental problems of children; support the routine collection and banking of biomaterials, and consider whole genome analysis.

Discussion: Dr. Tabakoff inquired if there is an increase in the frequency of FASD diagnosis, given that it may now be made on the basis of more subtle changes than dysmorphology. Dr. Warren responded that this is a major objective of the research agenda, including that of the Collaborative Interactive Fetal Alcohol Spectrum Disorders Program (CIFASD). In the U.S., fetal alcohol syndrome as a diagnostic entity is based upon three of the major characterizations of domains that are affected: the face, central nervous system, and growth. The frequency ranges from a half a case per thousand up to about two cases per thousand. It's much higher in countries where the CIFASD program and NIAAA investigators have done research. Researchers believe the numbers are much higher in the U.S., but don't have rigorous research to determine how much higher. Dr. Charness added that rates are higher in some other countries because the ascertainment is done differently than in the U.S. Dr. Li asked how diagnosis and recognition could be improved. Dr. Warren responded that new technologies are available, as well as the results of research on other developmental diagnoses, that can help achieve improved diagnosis. Dr. Charness noted that, without a diagnosis, children and families are not eligible to receive services. Plus, the diagnosis helps the targeting of specific services. To move forward will require a much more intensive analysis of the behavioral phenotype, more subtle facial dysmorphology and other deficits that would incorporate a wider circle of people through greater specificity and sensitivity. Noting that the field has good animal models, Dr. Li asked if there is a way to use these models for studies where the dose, the duration of exposure, etc., is controlled, and develop a spectrum or a quantitative set of biomarkers that would correlate with a dose/response relationship of exposure to alcohol in utero. Dr. Charness said that human studies and animal studies can complement one another.

Concurrence: Members of the Council expressed concurrence with the EAB recommendations.

Obesity and Alcohol

Dr. David Crabb, John B. Hickam Professor of Medicine and chairman of the Department of Medicine at Indiana University, presented a summary of research on the following topics: ethanol metabolism, adipose tissue biology, epidemiology of obesity, effects of ethanol on adipose tissue, drinking and risk of obesity, and risks of drinking in obesity.

Ethanol metabolism: Alcohol is a calorie-dense food. However, from a metabolic standpoint, it is not stored by the body as carbohydrates are, but burned by the liver in preference to anything else. There are currently unresolved questions about the ability of adipocytes and adipose tissue to metabolize alcohol. Metabolism converts ethanol to acetate. In some tissues it's possible for the acetate to be converted to fat. Otherwise, it is simply burned as an energy source.

Adipose tissue biology: Overweight is defined as a body mass index that is greater than 25 but less than 30; obesity is having a body mass exceeding 30. The difference between the lean and overweight individual is the amount of adipose tissue.

Adipose tissue is neither static nor inert. It consists of fat cells that have droplets of triglyceride in them. The fat cells are supported by connective tissue. Adipose tissue contains blood vessels, and preadipocyte cells. It also contains macrophages that come from bone marrow-derived cells called monocytes; macrophages are also found in the liver and intestinal tract. Macrophages in adipose tissue may interact in important ways with alcohol, as it occurs in other organs.

Normal adipocytes release fatty acids. They also make hormones such as adiponectin that facilitates the oxidation of fat in the liver, and leptin, which helps regulate appetite.

Adipose tissue changes as obesity develops. Animal studies show that as obesity develops, the fat cells not only get larger but adipose tissues also become infiltrated with cells that may be part of the inflammatory system. At some level of obesity, inflammatory signals change the adipocytes to make them resistant to insulin.

As adipose tissue becomes infiltrated with macrophages, these cells become activated to release inflammatory cytokines similar to a reaction to infectious agents. These inflammatory cytokines inhibit the ability of the preadipocyte to become an adipocyte and may make adipocytes themselves to revert to the preadipocyte stage. One of these cytokines is tumor necrosis factor (TNF). TNF was originally called cachectin; animals that have chronic infections become cachectic, i.e., they waste.

In summary, when the fat tissue becomes too large, it becomes inflamed, it releases cytokines such as TNF and higher levels of free fatty acids. This renders the liver and other tissues resistant to insulin, stimulates the formation of more glucose than usual, and thus induces diabetes.

Not only do these changes occur in fat tissue, but some of the cytokines that are released from the adipose tissue circulate and can have effects on other organs, such as the liver. When there are high levels of free fatty acids circulating, the liver is not able to oxidize all the fatty acids and release ketone bodies. Therefore, the liver stores the fatty acids, which contributes to the development of fatty livers. These are very common in people who are obese, as well as people who drink heavily.

Epidemiology of obesity: There has been an epidemic in obesity, with prevalence rates increasing over the years. Yet during this same period, levels of alcohol consumption have declined. States with the highest rates of obesity tend to be states where alcohol consumption is lower. Thus, obesity is not related to increased alcohol consumption at a gross epidemiological level.

Effects of ethanol on adipose tissue: Animal studies as early as 40 years ago reported that adipose tissue extracts were able to form acetaldehyde from ethanol and that alcohol blocked the conversion of glucose to glycerol (a molecule related to triglycerides). Another early study demonstrated that rats that had been fed a heavy alcohol diet had nearly 50 percent less fat mass than rats on a controlled diet. A later study confirmed this finding by establishing that chronic alcohol feeding impaired the ability of fat cells to convert glucose to triglycerides (fat). Thus, a paradox: up to a point, adipose tissue protects the body by storing fat. If it is unable to store fat, the fatty acids spill over into the liver and cause liver disease. At some point, therefore, obesity becomes risky.

Other animal studies indicate that chronic feeding of alcohol decreases the amount of adiponectin, which increases the ability of the liver to oxidize fat and secrete higher levels of TNF. TNF in turn reduces fat oxidation in the liver and causes insulin resistance.

Drinking and risk of obesity: In humans, a 1994 prospective epidemiological study compared non-drinkers to modest (less than one glass per day) drinkers. In women, alcohol consumption lowered the risk of gaining weight but it had no effect on men's weight. NHANES data shows that current drinkers who consume one or two drinks per day have a lower chance of obesity than non-drinkers. Binge drinkers, however, are at higher risk for obesity. A recent NIAAA review reported that those who consumed a small quantity of alcohol frequently (e.g., one drink per day with meals) were the leanest, while those who consumed a large amount infrequently (e.g., binge drinkers) tended to gain weight.

At the individual level, moderate doses of alcohol increase plasma adiponectin and reduce TNF alpha level. There is a suggestion that moderate consumption improves insulin sensitivity and may protect against Type II diabetes.

Heavy drinkers are likely to have lower body mass, lower fat mass, higher resting energy output, and greater rates of fatty acid oxidation, than others. These characteristics are reversed during abstinence, lending credence to the likelihood that they are related to alcohol consumption.

Risks of drinking in obesity: One study examined the effects of body weight and alcohol use on alanine aminotransferase, a commonly used liver test. Overweight people who drank more than two drinks per day had an increased risk of an elevated transaminase level. Among the obese, the sensitivity occurred at one drink per day. This is probably because the liver is seeing increased exposure to fatty acids and triglycerides from alcohol or obesity; combined, the insult is greater than either one individually.

A French study examined the risk factors for cirrhosis, alcoholic hepatitis, and steatosis (fatty liver). At each level of alcoholic liver disease, being overweight was added to the risk factor.

It is believed that alcoholic liver injury occurs because alcohol induces changes in the blood flow and the metabolic activity in the liver that makes it consume oxygen faster. The most common reason for a low oxygen level in the blood is sleep apnea, which is related to obesity. One review indicated that there appears to be a relationship between sleep disturbances and alcohol, but the studies are currently inconclusive.

Summary: Alcohol metabolism in adipose tissue may occur, but has not yet been well characterized. Adipose tissue in obese patients is both quantitatively and qualitatively different, i.e., the cells behave differently in part due to the presence of macrophages. Moderate alcohol use may protect against obesity and against diabetes. Obesity is clearly a risk factor for liver injury and alcoholic liver disease. Very heavy drinkers have altered adipose tissue mass and energy metabolism. Studying them may yield insights into the control of energy metabolism and the movement of fuel between the adipose stores and the rest of the body.

Discussion: Dr. Monti asked if there are implications in the research for the increasing levels of underage drinking and the epidemic of childhood obesity. Dr. Crabb found little research evidence addressing this topic. Dr. Tsukamoto inquired why there is a synergistic rather than an additive effect between obesity and alcohol, given that both affect liver change and disease. Dr. Crabb responded that the effect may be additive, given that low levels of alcohol consumption in a lean person lead to liver enzyme changes in an obese person. If there is a difference, it's probably related to how inflamed the liver becomes and how much fibrosis is present. There may be other factors occurring that are unique to alcohol. Dr. Tabakoff asked if there is sufficient data to examine the effect of a high fat diet combined with alcohol on obesity and liver damage. Dr. Crabb responded that there is a study from Japan that linked the level of polyunsaturated fat intake to higher risk of alcohol-induced liver disease. A study looking at the diet and non-alcoholic steatohepatitis (NASH) did not find any differences in dietary intake. Animal studies suggest that saturated fat protects against alcoholic liver disease, related to higher adiponectin production. Dr. Hoek questioned if information is available about the effect of interactions of medications and alcohol on the liver or other tissues among obese patients. Dr. Crabb replied that an induction of some of the cytochromes has been seen in both NASH and obese patients; this is being studied further. Dr. Sher inquired if the epidemiological studies comparing moderate and binge drinking were controlled such that the alcohol intake patterns were isolated, noting that binge drinkers have different eating patterns from others. Dr. Li stated the data came from NHANES; Dr. Monti suggested an answer might be found in Kathleen Grant's studies of binge-drinking monkeys. Dr. Mitchell wondered if the early studies examining the effects of moderate drinking on adiponectin, TNF and other cytokine or adipokine responses had been replicated with obese humans. Dr. Crabb said that there have been additional animal studies, but not in human beings. Dr. Cherpitel noted that in epidemiological studies, it would be good to know if the non-drinkers were lifetime abstainers or former heavy drinkers. Dr. Crews inquired about the effect of alcohol on the macrophages in fat tissue, given that alcohol appears to reduce the amount of fat in the body. Dr. Crabb said that 1) alcohol may be increasing the macrophage content of the fat; and/or 2) the increased level of TNF may encourage the adipocytes to revert to preadipocytes and hence reduce the fat. Dr. Crews asked if that suggests that healthy individuals who are not drinking have non-inflammatory fat whereas alcoholics have inflammatory fat, albeit not at the obese level. Dr. Crabb responded that it may depend on the lifetime drinking history of individuals, but that more research is needed to answer the question. Dr. Goldman inquired if the epidemic of obesity and the connection between obesity and even moderate levels of drinking on liver damage has begun to increase the prevalence of liver damage. Dr. Crabb replied that obesity has led to more liver problems being seen by providers, but it's not clear if the interaction between obesity and alcohol has had the same effect. Dr. Mitchell stated that the prevalence of cirrhosis has declined over the past 20 years because of increased clinical knowledge. Dr. Brown asked about public policy issues and how NIAAA could study issues related to the biology of alcohol intake and obesity. Dr. Crabb responded that NIDDK may be a more appropriate Institute to support such research, and that no one would suggest a person begin drinking for its health benefits, based on the epidemiological studies completed to date. Dr. Li noted research showing an association between intake of liquid calories and when they're consumed on body weight. This might explain the relationship of binge drinking and obesity. He also noted that binge drinking produces an elevation of both alcohol and acetate, which may explain differences in liver metabolism between binge and moderate drinkers. Dr. Zakhari asked if Dr. Crabb could identify differences in obese patients based on their history of moderate vs. binge vs. chronic drinking. Dr. Crabb replied that this question has not been studied.

Council Member Roundtable Discussion

Dr. Cherpitel and Dr. Sher reported on a Center for Scientific Review (CSR) open house on the social and behavioral research area that they attended on April 25, 2007. The 180 attendees were charged with answering two questions:

1) Is the science of your discipline, it in its present state, appropriately evaluated within the current study section alignment?
2) What will be the most important questions and/or enabling technologies you see forthcoming with the science of your discipline in the next 10 years?

Participants were divided into six breakout groups. These included Basic Science (two groups); Epidemiology and Biostatistics; Health Services and Demography; Risk, Intervention and Prevention at the Individual or Small Group Level; and Risk, Intervention and Prevention at the Large Group or Community Level. Study section chairs and CSR representatives led each breakout group, which constrained the discussion. In general, CSR and the study section chairs felt the assignment of grants to study sections and the review process worked fairly well; CSR reported on a survey of grantees that showed over half were happy with their reviews, interpreting this as positive without reporting the opinions of the substantial minority. Dr. Sher noted that some researchers feel their applications are not assigned to the correct study sections or that some areas, such as human pharmacology and pain research, are not well represented. There appeared to be broad consensus across the breakout groups about the kinds of technologies that will be important for the field in the future. Presentations at the open house addressed changes in the review process, including shorter applications, electronic reviews and plans for review orientation training. A full report on the open house may be found on the CSR web site. Dr. Charness stated that the Executive Committee of RSA is considering a survey of its membership about the grant review process and a report on their findings to the Council. Dr. Harris stated that he thought the current review process is not working at this time of fiscal stress, and wondered if there is a more objective or quantitative way of assigning priority scores. Dr. Sher noted that one of his colleagues who served on a peer review panel reported that today the technically perfect grants get funded, not necessarily the most creative ones; Dr. Cherpitel confirmed that this was one of the findings of her breakout group. Dr. Mitchell suggested that the MERIT Awards might be used to fund such innovative research. Dr. Hoek stated that shorter grant applications might focus more on concepts and directions instead of technical issues. Dr. Li acknowledged long-term issues with the priority score system, and noted that the current shortage of funding is accentuating the problem. He also pointed out potential problems of shorter applications and the challenges of working with a large number of technical reviewers, many of whom may have expertise related to a small number of grants yet vote on all applications before the study group. Dr. Zakhari raised the problem of alcohol applications being assigned to study sections where there was no interest in alcohol and therefore receiving a low score. Dr. Warren said that no systematic study to ascertain the impact of study section assignment has been done. General Dean inquired if applications to NIAAA were leveling off due to the problems in the review process. Dr. Li explained that the scoring process was an NIH-wide problem and that NIAAA tried very hard to maintain a high success rate among its applicants, encouraging amended applications within the same year. His larger concern is that the field may have reached capacity and there are an insufficient number of new and young investigators pursuing research in the area. Dr. Faden asked if there was any discussion at the open house about limiting the number of amended applications that could be submitted. Dr. Sher reported that this topic was not addressed and lamented the economic costs of re-submitting applications in a quest for perfection. He asked how NIAAA-reviewed grant applications fared when sent to CSR. Dr. Bautista stated that the majority of R01 grants go to CSR and are not reviewed at NIAAA. Dr. Hoek stated that prior to 1993, NIAAA grants exceeded the NIH average in success rate; they leveled off in 1993 when CSR reorganized the study sections and eliminated many of the alcohol study sections. Dr. Li replied that the issue is whether there is sufficient clustering of grants from NIAAA; the creation of increasing numbers of study sections distributes each Institute's grants on a wider basis, but NIAAA has a smaller number. Overall, the Institute's success rate is high compared to most other Institutes. But the success rate will go down in the future because of reductions in future year funding, e.g., not allowing cost of living increases in subsequent years. Dr. Ehlers suggested there is cross-sectional data that would allow a comparison of how grants fared in study sections with a large number of alcohol reviewers, compared to study sections without such representation. She believes that applications sent to the latter category receive lower scores and this discourages young investigators.

Consideration of the February 2007 Minutes and Future Meeting Dates

Council members voted unanimously to approve the minutes of the Council meeting of February 7-8, 2007. Upcoming Council meetings will take place on September 19-20, 2007; February 6-7, 2008, June 4-5, 2008, September 17-18, 2008; February 4-5, 2009, June 10-11, 2009, September 16-17, 2007 (subsequently moved to September 19-20); and February 3-4, 2010, June 9-10, 2010, September 15-16, 2010.

Ex-Officio Member and Liaison Representative Reports, and Public Comment

There were no comments.

Adjournment

Dr. Li adjourned the meeting at 1:45 p.m.

I hereby certify that, to the best of my knowledge, the foregoing minutes are accurate and complete.

<>/s/

Ting-Kai Li, M.D.
Director
National Institute on
Alcohol Abuse and Alcoholism
and
Chairperson
National Advisory Council on
Alcohol Abuse and Alcoholism

/s/

Abraham Bautista, Ph.D.
Chief
Extramural Project Review Branch
and
Executive Secretary
National Advisory Council on
Alcohol Abuse and Alcoholism

Prepared: October 1, 2007