Creaky NIH is past its prime

July 12, 1998|By Daniel S. Greenberg

CONGRESS wanted to know how spending decisions are made at America's favorite government agency, the disease-fighting National Institutes of Health. The establishment organization to which it assigned the question last year has now provided predictably mushy and soothing answers that NIH can easily accept: Everything is OK at NIH, but would be even better if the NIH public-relations operation were revved up considerably.

In fact, much is far from OK at NIH. And the difficulties wouldn't be eased by that prescription, which calls for greater "outreach" and a bigger role for "the public" in decision-making at NIH headquarters. Those are the central recommendations by the Institute of Medicine, the health-policy arm of the National Academy of Sciences, long ago chartered by Congress as science adviser to the government.

Plague of lobbyists

"The public" in the recommendations translates into organizations -- usually run by lobbyists for hire -- demanding bigger budgets for their diseases, whether or not it makes scientific and medical sense to spend money to their liking. "Outreach" means press releases and meetings concerning the world's biggest bankroll for medical research and training in universities and hospitals, plus a small share for NIH's own laboratories. The NIH budget, now $13.6 billion and en route to at least a $1 billion increase next year, accounts for 37 percent of all federal research spending for civilian purposes.

The real problem at NIH is not lack of public input, which now comes in torrents that NIH wisely tries to ignore as narrow-minded and ill-advised. Rather, contrary to the chronic complaints of the biomedical-research community, the problem is an excess of public money pumped into an aged institution that's creaky with bureaucratic arthritis and beholden to old retainers past their scientific prime.

The postwar rise of federal science spending has produced a nationwide network of medical research institutions that are economically important to their surrounding communities, politically well-connected to Washington, and financially dependent on NIH's largess -- regardless of their scientific productivity.

Critical questions about NIH funding promptly evoke a barrage of rejoinders from one of the best-financed lobbies in Washington, the Association of American Medical Colleges. Though several independent inquiries have concluded that the nation is producing too many physicians, the association staunchly defends the survival of all 125 of its medical-school members -- and the continuation, and growth, of NIH support for their laboratories and staff researchers.

The NIH management contends that its research money is awarded to the best through intensive review and competition. But there has never been a thorough inquiry into the quality of NIH decision making. With colossal sums at its command, it has compiled a lustrous record of having financed innumerable great discoveries and nearly 100 Nobel-prize winners. But, as might be expected, biomedical research now and then produces a scientific blockbuster that got the cold shoulder from NIH. A case in point is the discovery 20 years ago of an amino acid in the blood, homocysteine, that is now considered to be a major source of heart disease, perhaps on a par with cholesterol. But, as described in the New York Times Magazine last year, the discoverer, Dr. Kilmer McCully, was consigned to scientific oblivion because his findings conflicted with NIH's reigning dogma of cholesterol as the culprit in heart disease. A frequently heard criticism is that the aging NIH system is infested with scientific conservatism and that grant applicants prudently hold back novel proposals that might raise doubts among the scientifically orthodox.

More money won't solve that problem. Since the public and politics demand more medical research, serious consideration should be given to capping the present NIH at its current size and deploying future growth in government medical-research spending to a new organization. Call it NIH II. Plant it far from the present NIH, and let it begin with a clean slate.

The issue isn't bureaucratic pride. It's the prevention, alleviation and cure of disease.

Daniel S. Greenberg is a visiting scholar in the history of science, medicine and technology at Johns Hopkins University, where he is writing a book on post-Cold War science politics.

Pub Date: 7/12/98

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