Beyond CFRI: Research Funding and the National Institutes of Health

By Thomas P. Stossel, M.D.

Fall 1994

The following article was taken in part from "Commentary, Current Opinion in Hematology," 1:1-3, 1994 Current Science.

Editor's Note: Dr. Thomas Stossel, Director of the Experimental Medicine Division and senior physician in the hematology/oncology division of Brigham and Women's Hospital recently wrote the following commentary. As you read, keep in mind that less than 10% of non-industry Research & Development funds come from private charities such as CFRI or the CF Foundation. And while the pharmaceutical industry also makes important contributions to biomedical research, these funds are primarily directed toward projects that provide short-to-intermediate-term profits. The National Institutes of Health (NIH) plays a unique role in funding a much broader scope of biomedical research, but as Dr. Stossel explains, that role has been severely restricted.

The Funding Problem

The past 20 years have seen a steady increase in the competition for NIH research grants. The acceptance rate of grant proposals has fallen from about 50% in the 1960s, when peer review groups evaluating applications allowed for the funding of proposals ranked as "very good," to 20% a few years ago, when an application had to be at least "excellent." Today the odds have sunk to one in ten (10%) or less, meaning that to have even a chance at getting funding, a grant application must be considered "high outstanding."

In this situation the critical feedback by peer review to applicants has become dysfunctional. It is difficult for reviewers to come up with reasons to explain what is "wrong" with a perfectly good but not "outstanding" proposal. The grant review process is discouraging for the reviewers, who see the extreme emphasis on novelty and immediacy that the dearth of funding has caused, and ultimately the many excellent proposals that continue to go unfunded.

How Serious is the Problem?

Even outstanding scientists now devote an inordinate amount of time to writing grants, knowing that their proposals are highly vulnerable. The most "outstanding" researchers do manage to obtain NIH grants-albeit with slashed budgets-and supplement this funding with sums from private organizations, most of which can only support the more well-established scientists.

But scientific breakthroughs arise from the incessant incremental progress of ordinary science, and there are numerous examples of important developments arising from unexpected discoveries made by researchers systematically studying seemingly mundane subjects. Routine research is necessary to transfer new discoveries into technologically useful products and into treatments for disease. Even oddball and seemingly trivial observations, when integrated into the total picture, add strength to the overall understanding of scientific principles and systems.

Typical Responses Do Not Work

The funding crisis is a case of opportunity outrunning resources, rather than a willful decision by the Congress, which appropriates NIH funds, to curtail research. As a federal agency, the NIH cannot lobby for itself, other than to respond to Congressional inquiry, and it must accommodate cutbacks in congressional allocations. Congress and the executive branch, in fact, have been relatively generous to the NIH compared with many other spending programs, although in comparison with the total federal expenditures for science, which includes space and defense research, the NIH appropriations have been relatively small. Increasingly, the political will to allocate adequate money for biomedical research has weakened against the background of deficit reduction. Many politicians acknowledge that biomedical research improves health, creates jobs, and returns value on investments well in excess of the money spent. But the promotion of biomedical research doesn't currently attract many votes.

The Proposal

Probably a doubling of the NIH budget over the next five years would be required to accommodate real growth, fueled by an influx of newly minted researchers capable of doing excellent research. In terms of the total health care budget, these are relatively small sums. But to acquire this money, the biomedical research community will have to mobilize the general population to send a simple message to their legislators: "We want more NIH funding for medical research of all kinds. We cannot progress further without more research." Most diseases are represented by voluntary health organizations or specialty medical societies. The organizations, as patient advocates, are tied to the grass-roots, and they collectively represent tens of millions of people. They perform valuable services for individual patients afflicted with specific diseases. They advocate for research and even fund it, which gives them great credibility in Congress when they ask for NIH funding for research. However, I believe that they could achieve incrementally more by the simple act of encouraging their constituents to rise up and appeal to Congress on behalf of NIH-supported research of all kinds.

Support for research could also be directed toward implementation of Senators Harkin (D-IA) and Hatfield's (R-OR) imaginative proposal. They promote a "Research Fund" which would work to increase NIH funding in two ways: by giving NIH 1% of every dollar paid in health insurance premiums, and by inviting taxpayers to make a donation to the NIH by filling in a blank on their federal tax-return forms. As this bill is attached to the Health Care bill, it is currently stalled until 1995.

In the final analysis, our support of the NIH is directly related to our support for additional scientific research of any kind.

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