House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) has put forth a proposal for reforming the National Institutes of Health (NIH). The NIH is arguably the most important health and science organization in the U.S. Since the NIH is the biggest funder of biomedical research, what it does and how it operates will in turn affect scientists and science throughout the country. In turn, this will affect the health of practically all Americans. The big question then is how much of this proposal is actually based on, you know, health and science versus politics.
That’s because in recent years, a number of politicians have tried to politicize the heck out of science. So, while many scientists and health experts may agree that the NIH is need of significant reform, you’ve got to look skeptically at any reform proposal put forth by any politicians rather than actual science and health experts. After all, would you watch a movie directed and produced entirely by politicians? Would you feel confident in an Olympic team that was coached and trained completely by politicians rather than people who, oh, actually played the sports themselves?
Which, if any, real scientists and health experts built the proposal?
Yeah, a closer look at the “Reforming the National Institutes of Health, Framework for Discussion” document from Rodgers shows little evidence that the proposed changes to the NIH originated from actual science and health experts. In an opinion piece published in STAT, Rodgers, who is not a scientist, researcher or health expert, and House Appropriations Subcommittee on Labor, Health and Human Services, and Education Chair Robert Aderholt (R-AL), who is also not a scientist, researcher or health expert, advocated for the proposal and wrote: “Our message to scientists, researchers, patient advocates, colleagues, and the American people is simple: Our door is open. Work with us. Be a partner.”
Umm, imagine people building you a house that you have to live in and then telling you, “Hey, we didn’t bother getting your opinion when we were designing and building the house. But you’re welcome to try working with us now.” Yeah, that’s not the same as letting you design and build the house from the start. Plus, how much assurance is there that they they will even listen to your suggestions? Rodgers and Aderholt did not make it clear which scientists and health experts they would allow to be their partners and how.
What is the scientific rationale for the proposed new organizational structure of the NIH?
Rodgers’ document also proposes a major restructuring of the NIH— condensing the NIH’s current 27 institutes and centers (ICs) down to 15—without offering much scientific rationale for the proposed new alignment. For example, why does this new arrangement seem to throw all of the other organs like the heart, lungs and gastrointestinal tract into a National Institute of Body Systems Research yet still keep the brain and nervous system separate in a National Institute of Neuroscience and Brain Research? Anyone who has tried to hold in a fart knows that the brain is typically connected to other parts of the body.
Moreover, the intended purposes of many of these new ICs are not very clear by their rather ambiguous names. For example, having a proposed National Institute for Health Sciences Research seems a bit odd since isn’t “health science research” kind of what the entire NIH should be doing? It’s not as if the other institutes would be doing “stuffed animal science research.” The same goes for the National Institute on Innovation and Advanced Research. Does this mean that the other institutes and centers will support non-innovative and not advanced research?
All of this doesn’t mean that the NIH isn’t in need of major restructuring. A lot of the basis for the current structure of the NIH emerged decades ago—in some cases even before the 1970s leisure polyester suits were popular. In the same way that adding fashion accessories won’t override the fact that you are wearing a leisure suit to a date, simply adding to or tinkering with the current NIH structure may not fix deeper problems with the existing structure. For example, keeping the ICs separated by body parts and certain diseases may continue to favor “I only look at the back of the eyeball” siloed approaches when more integrated systems approaches are needed. So, yes, an overhaul of the NIH structure might be warranted—but it should proceed in a manner warranted by science and not political whims.
Will the proposed changes make it easier or harder for scientists to conduct research?
If you want good science to be done, ultimately you have to make it easier for scientists to do research. And this hasn’t been happening since the 1990s with the amount of funding allocated each year to the NIH barely keeping up with inflation. That’s despite the population growing in size and increases in the cost of doing science outpacing inflation. NIH funding has become the lifeline for most independent biomedical researchers—independent meaning not working for a company selling particular products. Yet, Rodgers’ proposal does not acknowledge the fact that the relative shortage of NIH funding has meant that NIH grants have gotten a lot harder to get over the past several decades.
Her proposal also does not address the increasing administrative burden that scientists have faced. Few scientists probably said as kids, “I want to do science so that I can fill out forms and attend meetings.” Yet, Rodgers’ proposal introduces even more reporting requirements for NIH grantees without trying to reduce the existing administrative burden faced by scientists.
Then there’s been the decreasing job security for scientists who often find themselves constantly on a grant-hunting treadmill searching for funding to support their research operations and keep their positions. Many academic and research institutions have turned to the ‘soft money’ model where the moment you can’t bring in enough external grant money is the moment you don’t have a real salary. And having a salary is sort of important to eating and stuff like that. When it’s easier to make money being a YouTuber or TikToker and selling stuff, guess which direction scientists and potential scientists may go.
Things would become even tougher for scientists who have been highly productive with Rodgers’ proposal to limit researchers to holding no more than three NIH active grants and awards at a time. Ummm, things don’t work too well when you effectively tell successful people, “Yeah, we don’t want you to become too successful.” If you want to provide more support to newer scientists, you can’t just slice up the same pie in a different way. You’ve got to make the overall pie bigger.
Additionally, Rodgers’ proposal talks about stimulating more innovation but doesn’t concretely explain exactly how that is going to happen. That’s like saying, “You really should try to be attractive on a date.” True innovation comes with freedom and resources when scientists feel freer to take risks and not have to worry constantly about things like finding funding and job security. You don’t tell someone clinging on to the edge of a cliff, “Take some time to be innovative. Try something new.”
Finally, there’s the whole anti-science thing that scientists are facing right now. With so much misinformation and disinformation about science out there and heavy politicization of things that should be scientific issues like climate change and Covid-19, the last thing you want is to have politicians decide how science is going to be funded and conducted. Why not let actual scientists do that? Congress could commission independent committees of scientists, health experts and patient advocates to design and propose new structures for the NIH. These can be done in a transparent manner that allows broader public input and shows how such input is being considered.
If you look back at American history, this country’s original founders included scientists like Thomas Jefferson and Benjamin Franklin. Its rise to world preeminence was fueled in large part by scientists (including many who immigrated from other countries) and scientific innovation. In the same way, whether America grows or declines in the future will depend on what science is done and whether it’s led and done by real scientists rather than politicians. After all, science is not something that you can fake it until you make it. And good science tends to build a nation while the lack of science can tear it apart.
