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<jats:p> These are difficult times for the U.S. National Institutes of Health (NIH). Its 2011 budget is 1% less than in 2010, and it is increasingly common for NIH to administratively decrease the size of awards across the board, before money goes out the door. The federal stimulus package buffered the impact of NIH budget issues. For example, approximately 36% of NIH grant awards derived from the stimulus in FY 2009 were individual research awards (R01s). <jats:xref ref-type="fn">*</jats:xref> But the prospects moving forward are bleak, given the absence of stimulus funds and the building momentum for cutting federal discretionary spending. There have been 5 years of no real growth in the NIH budget, explaining in part why the number of grants awarded for research ideas originated by individual scientists (untargeted R01s) has been stagnant. <jats:xref ref-type="fn">†</jats:xref> It also explains why paylines (the percent of applications funded) are at or near record lows. NIH Director Francis Collins recently testified before a Senate subcommittee that in FY 2011 only 17 to 18% of grant applications would be funded, the lowest level on record. Because collective funding efforts, such as program project and center grants, as well as targeted R01s (responses to specific program announcements from individual NIH institutes), also compete with the bottom-up R01 program for funding, innovative investigator-initiated research is in dire straits. This critical part of the NIH research effort forms the basis for future medical progress and must be returned to good health. </jats:p>