when it comes to breakthroughs that could cure — not just treat — the most expensive diseases, government is unique. It alone can bring the necessary resources to bear… And it is ultimately on the hook for the costs of illness. It’s irresponsible and shortsighted, not prudent, to let financing for basic research dwindle.
But as Yuval Levin pointed out in 2007, the NIH budget was doubled from 1998 to 2003 and the results were in many ways disappointing. The rapid funding growth was followed by an abrupt stall.
The glut of graduate students enticed by the growing support a few years ago have since found it difficult to get their own work funded once they finished their training, and the sudden deceleration in funding has left many researchers feeling slighted even though their funding grew by leaps and bounds in the past decade. Slower growth over a longer period would have offered a far more stable and sustainable means of expanding the American biomedical research enterprise.
Moreover, Levin correctly noted that Congress missed the opportunity to overhaul
the agency’s exceedingly inefficient and bulky institutional structure [27 separate Institutes], which both wastes resources on needless duplication of administrative overhead and is so specialized that it creates overly rigid and nearly permanent channels of funding.
So if you were redesigning the NIH, what would you do? Here are four proposals:
- Wind down most of the NIH intramural research and direct the funding to the competitive peer review process. Perhaps the intramural laboratories should be spun off with endowments. The point would be to make them compete on an even footing with other scientists.
- Continue to develop the NIH information infrastructure in support of science. PubMed isn’t broken, so don’t fix it. Let’s figure out how to make national repositories for clinical data work better.
- Bring the many other federal and quasi-federal health research institutions into the NIH. I refer to the Agency for Health Research and Quality, the Centers for Disease Control, the Center for Medicare and Medicaid Services, the Patient-Centered Outcomes Research Institute, and the research wing of the Substance Abuse and Mental Health Services Administration. The goals pursued by these agencies should always have been part of the NIH’s mission.
- Break up the silos of the NIH Institutes and rebuild its programs around a few big scientific themes. How about these?: I. Origins and determinants of health and disease. II. Treatment research. III. Health systems and services delivery. IV. Informatics, Research Methods, and Ethics. Whatever scheme is chosen, it should have a definite sunset and be reviewed at least every 20 years.
There are many other issues. Did the recent reform of peer review succeed? Are you satisfied with the system of paying indirect costs on extramural grants? Should we have more support for scientific careers and less for specific projects, or the reverse?
h/t to Ramesh Ponnuru for the link to Yuval Levin.