Part 8: Concluding Thoughts
Size, Reproducibility and Intramural Funds
The NIH is, and will continue to be, the driving force behind American and global bioscience research.
No other organization comes close in scale or scope. The next largest bioscience funders are corporations focused on profit, which spend their money on clinical research for drugs developed based largely on NIH-funded research. Most foreign government agencies and nonprofits that fund basic research have an order of magnitude less funding. The only organizations that could compete with NIH funds are tech giants, but they are constrained by profit motives that prevent them from dumping shareholder dollars into unpredictable basic research.
the NIH is simply irreplaceable. If it had never existed, bioscience would be far behind its current progress. If it blinked out of existence, the industry would collapse.
Thus, the NIH is simply irreplaceable. If it had never existed, bioscience would be far behind its current progress. If it blinked out of existence, the industry would collapse. There are simply no organizations or forces that can fill its void. It is a shining example of proper government in action, an agency that puts money into public goods with tremendous positive externalities.
With great money comes plentiful flaws, however. The NIH produces plenty of good research, but that’s also a function of the sheer amount of its funding. Between 1990 and 2020, it spent more than a trillion dollars (in 2020 dollars).
And, in return for some good research, the NIH has become a gravity well that warps the entire bioscience research industry, seeding it with distortions and bad incentives. At best, the NIH has wasted an enormous amount of taxpayer money on low-value work; at worst, it is partially responsible for the monstrously inefficient and costly university system, it has inculcated an entire generation of scientists with bad habits and it has failed to upkeep standards in bioscience research.
The Reproducibility Project: Cancer Biology — a crowdsourced project — aimed to replicate cancer biology studies published between 2010 and 2012. But out of 23 high-impact studies, “fewer than half yielded similar results,” according to reporting by Science. The project originally flagged 53 papers for replication experiments, but “vague protocols and uncooperative authors” meant that just 23 could even be tested.
Perhaps these issues are limited to the NIH’s extramural program, though. The NIH itself — its intramural program — is possibly the best facility on earth for a bioscience researcher. Intramural researchers are given unprecedented access to resources and connections. They are free to pursue far-reaching ideas.
Working within the NIH, though, is rife with bureaucratic red tape. As a federal employee, many scientists carry out excellent work, but often at the cost of millions of dollars in personal income, at least in the long run, due to low government salaries. Most researchers would prefer to roll the dice with a biotech company, even if it means giving up the dream of basic research.
Researchers who remain in the NIH system are also dominated by entrenched interests – the major universities, top researchers and their labs – and often seek to join them. Ever since the Boom Decade from 1993-2003, when the NIH’s budget more than doubled, this government agency has been a covert feeding trough for some of the most lavish rent-seekers in the country.
Slow and Steady
Yes, the NIH has flaws. The study sections need to be reformed, grants should probably be more widely distributed, indirect costs are perhaps too high and more money should be put aside for basic science and high-risk projects.
But these are natural flaws endemic to any giant bureaucracy, especially in the government. Some are caused by rent-seekers, some by bureaucratic inertia, and some by necessary, but annoying, government safeguards designed to protect taxpayers and prevent conflicts of interest.
All things considered, the NIH leadership has done a remarkable job at containing these problems. They don’t have the murky autocratic power of a university president, nor the narrow profit goals of a private company leader, but suffice instead as appointees and hires of presidential administrations. NIH leaders quietly serve as stewards of scientific research, while appeasing whatever random noise comes from their political overlords. Often, that means making non-ideal compromises. And despite all that, the NIH’s budget has quadrupled in the last thirty years and the organization remains largely immune from political influence. Being a leader at the NIH is a thankless task, and it’s impossible to come away unscathed, but we should be Francis Collins and his team have done as well as they have.
By juggling political influences and serving as ‘quiet’ leaders, though, impactful research often goes unfunded. There is, perhaps, a need for more trend-chasing at the NIH.
The NIH has sacrificed bioscience research dynamism in favor of a tedious, but safe slog. The United States and the world have probably missed out on countless medical breakthroughs because the most daring researchers and projects are never funded. A great mass of NIH-funded researchers, instead, produce work of incremental value. Researchers have accepted a Faustian bargain, whereby they play along with the system and lie on their grants for the sake of longevity in their career.
Ideally, ambitious researchers could go outside the system and get private funding, but the NIH has made that almost impossible. The entire industry has been warped to NIH standards. University labs and private foundations can’t survive without NIH money, so they too hire conservative researchers who are good at getting NIH grants, and those researchers train younger researchers to be conservative, and so on. A few lucky researchers can get money from the rare, well-run private institute, like the Howard Hughes Medical Institute, but there is precious little good money to go around.
Entrenched Interests
Famous researchers and universities derive lopsided benefits from the NIH, and that poses tough questions about the fair use of taxpayer funds. But these concerns are overstated by critics (many of whom feel personally slighted about not being a member of those same entrenched interests). The NIH has a responsibility to promote good science, and not to give away money in an arbitrary manner. Bioscience follows the 80/20 rule, just like everything else, so of course a fairly small percentage of researchers and universities will produce the best work and therefore will get the most NIH funds. To do anything else would be putting politics ahead of science.
The NIH’s favoritism for entrenched interests has also solidified the most elite education system in history. The US’s combined research universities are incomprehensibly better than any other nation’s. Outside of maybe the U.K. and China, there are scant countries with even three universities comparable to the US’s top 20 schools. The NIH and other federal research agencies deserve a lot of credit for building these institutions to their current heights.
Perhaps the selective dealing of funds to the most influential universities, though, is not a good thing. Elite universities already have their own multi-billion dollar endowments. They are given further, taxpayer-backed dollars by the NIH to build laboratories and expand their bureaucracies for their own profit and prestige. These universities have gamed this system perfectly; armies of accountants, lawyers, and administrators have blown up school budgets and then expertly negotiated with the federal government to get more of it covered by the taxpayer through rising, indirect costs. When the Boom Decade ended, it was not the universities that suffered; it was the legions of researchers suckered into becoming cheap labor in their bloated research programs, despite grim job prospects.
These well-funded universities also coax political connections in Washington D.C. to ensure that the NIH maintains its status quo. Any whiff of real reform, whether to give more grants to younger researchers, cap grant amounts, or reduce indirect costs, is hindered by phone calls and popular backlash from rank-and-file researchers.
Meanwhile, the hapless NIH leadership is beset by do-gooder advocacy groups, lobbyists, and politicians who push the NIH to support one cause or another with no understanding of the big picture. The sway of political winds or lunch with the right Congressman could shift millions of dollars to one place or another over the objections of wise stewardship. And somehow, despite all this, when there is good reason to rapidly move funds around the NIH — such as when the biggest pandemic in modern history kills millions of citizens — red tape and lethargy prevent America’s largest public health agency from doing much to combat the problem for months.
In response to these issues, NIH supporters suggest incremental reforms which either never happen (like grant size caps), or do happen and then get immediately canceled (like the Grant Support Index), or they happen and don’t work (like the Next Generation Researchers Initiative).
Forward Facing
These issues are not enormous, nor are they impossible to solve. With sufficient political will, good leadership, and careful politicking, incremental reforms could curtail these issues.
We know these flaws can be fixed because the NIH is one of the vanishingly few government agencies that has legitimate esprit de corps. I personally haven’t talked to anyone who works at the Department of Energy or Transportation or Commerce, but I doubt they love their bureaucracies as much as many of my interviewees love the NIH. Many top scientists probably think that the NIH is the single best part of the U.S. government.
Best of all, we know an easy fix to many of the NIH’s problems: increase its budget.
More money means more funds for young researchers and smaller institutions. It means less arbitrary study sections. It means more specialized, high-risk grants. And best of all, it means more money going to invaluable bioscience research. A higher budget, though, should also be treated with care.
More money would alleviate some of the NIH’s problems, yes, but in the long run, it could make them worse. So many of the NIH’s modern issues were caused by its great influx of funds during the Boom Decade, which not only threw open its structure to rampant exploitation, but entrenched the NIH’s dominant role as a gravity well in distorting the rest of the bioscience research industry.
Giving the NIH more money could lead to more of the same. More low-margin research will be funded by a hopelessly broken study section system. The universities will take more money for their giant, new laboratories and colossal administrative staff. The entire bioscience industry will have an even stronger incentive to base all of its standards on the NIH. Bioscience as a whole could slow in the long run.
What bioscience needs is not more money placed into a giant centralized government bureaucracy that’s been dominating an entire field of science for three quarters of a century, but rather genuine reform. Maybe the NIH could be fixed, but that would require politically impossible maneuvers, like breaking it into smaller pieces, or allocating many of its grants randomly, or eliminating the entire study section system.
One alternative is a complete restructuring of the bioscience industry and the ushering in of new organizations and players to fill the NIH void — private companies, philanthropists, and more agile government agencies. Short term chaos is probably unavoidable, but in the long run, bioscience will be healthier without the NIH in its current form.
And despite all this — despite the duality of the NIH, its triumphs and failures — it is undoubtedly one of the great success stories of the American government. It is a federal institution that has invigorated a valuable public service and has built a vast wealth of knowledge that has translated into incredible inventions and the saving of countless lives.
“And despite all this — despite the duality of the NIH, its triumphs and failures — it is undoubtedly one of the great success stories of the American government.
