Science and Society: Funding the National Institute of Health

Despite the polarization of politics, Republicans and Democrats continue to unite on at least one issue: National Institute of Health, or NIH, funding. I was pleasantly surprised by Newt Gingrich’s Op-Ed, “Double the NIH Budget” in the New York Times last Wednesday, in which he argued in favor of raising the NIH budget to 60 billion dollars because investment in biomedical breakthroughs would offset future health costs.

Other Republicans have also rallied around the cause of NIH funding. Presidential candidate Jeb Bush, former House Majority leader Eric Cantor and self-identified Tea Party member Matt Salmon, U.S. Representative for the 5th district of Arizona, have all enthusiastically called for increases in the NIH budget.

There are several reasons for the recent upwelling of political support. NIH funding is politically low hanging fruit; it looks good on a candidate’s resume, and no representative wants to oppose finding cures for disease. Health resonates with everyone because it is personal. The Tea Party Representative Matt Salmon explained why he supported NIH funding, saying, “As a conservative Republican,

I believe the fiscal health of our nation is one of the most critical issues long term. But I want to fight this fight, I’ve lost too many friends to cancer, and I don’t want to see another person succumb to this.”

I’m cautiously optimistic about the future of the NIH. Although its funding has stagnated for the past 10 years, and it’s easy to pay lip-service to biomedical funding without actual action, there appears to be a genuine growing push to increase its funding.

I think increasing NIH funding is important and should be celebrated, but I’m not as confident as these politicians that it’s the panacea for all our health woes. They present a politically convenient but oversimplified vision for improving American health care, ignoring many nuances. In particular, we have to address ballooning health costs, increase funding for other scientific disciplines and fix systemic flaws within the NIH.

The United States already spends 15 percent of its GDP (roughly the GDP of France) on health care, and by 2020 healthcare expenditures are expected to increase to 4.6 trillion dollars. The main drivers behind increasing healthcare costs are an aging U.S population and increasing drug and medical device prices. I hope Newt Gingrich is right, and that new drugs will lower healthcare costs by finding cures for ailments that are currently expensive to treat. It’s also possible that biomedical research will only lead to new, expensive devices and drugs that only marginally increase life expectancy while driving up health care expenditures to the detriment of other important causes. We have to make sure that new medicine not only increases our life expectancy, but is also affordable. With an aging society, we have tough decisions ahead about how much money we are to spend on age-related illnesses and end-of-life care.

While biomedical research has undoubtedly contributed to the increase in life expectancy from 70 years to 80 years in the past half-century, advances in medicine have also come from basic research in other scientific fields. Physicists gave us medical imaging and radiology, engineers gave us prosthetics and medical devices and computer scientists have given us electronic medical records and bioinformatics, to name a few examples. But despite the importance of these other fields in regard to medicine (not to mention all their other applications), their funding has lagged in the recent decades. National Science Foundation funding has stagnated around 8 billion dollars, and since 1996, mathematics, the physical sciences, engineering and computer science have all seen a decrease in their share of academic research and development funding. Congress shouldn’t just focus on the NIH to the detriment of other basic sciences.

Systemic problems within the biomedical research community also exist, which won’t be solved by increasing funding. An environment of hypercompetition exists where scientists are having a harder time funding their research and grant success rates hover around 20 percent. Only 15 percent of postdoctoral researchers are able to find a tenure-track position within six years.

Hypercompetition has negative consequences and has harmed the research community. Less bold and creative ideas are funded because scientists and grant-review panels are more likely to stick to old, less risky ideas that have worked in the past. Scientists rush to publish in prestigious journals like Nature and Science because it means a greater likelihood of getting grant money in the future and evidence shows that in recent years this has led to greater fabrication of evidence and the cutting of corners. There were almost ten times as many retractions in 2010 as there were in 2000. In a competitive environment, scientists are also less likely to work together for fear of getting scooped, and scientific progress becomes slower.

Increasing funding wouldn’t solve the problems that lead to hypercompetition. The doubling of the NIH budget from 1998 to 2002 did little to stop the plummet in grant success rates. The best way to fix the problem is to limit the number of biomedical graduate students and postdocs in the United States. Currently, labs train more graduate students and postdocs then there are research jobs because they lead to greater publication output. But this Malthusian system leads to too many people competing for a limited number of job openings. Instead, permanent staff scientists could replace many graduate students in labs. Larger labs would be forced to shrink, and grant funding would become less competitive and be distributed to more projects.

Fixing biomedical funding doesn’t just concern the community of biomedical researchers; it is an issue we should all be concerned with because it ultimately determines the quality of biomedical research output. The United States has led the way for cures in the past, and it’s in our best interest to support a strong biomedical research community so we can continue to make headway in improving our nation’s health.