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Vol. LVIII, No. 13
June 30, 2006
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'NIH at the Crossroads'
Zerhouni Addresses Advisory Councils, Scientific Societies

On the front page...

Providing a strong message backed by a storehouse of data, NIH director Dr. Elias Zerhouni is touring all of the institute and center advisory councils this spring, as well as speaking before a number of scientific societies such as FASEB. He is on a mission to educate an influential percentage of the agency's more than 31,000 outside counselors about NIH's current budget situation: Yes, the budget doubled between 1998 and 2003, but that created a flood of applications that subsequent relatively flat budgets could not hope to reward. As the success rate for competing for an NIH grant dips from a traditional one-third of all applicants to about 1 in 5, there is discontent and there are misperceptions that need addressing.

Continued...

 
  NIH director Dr. Elias Zerhouni addresses the NIA advisory council on May 24. He has been visiting council meetings and scientific societies.
In a presentation he titles, "NIH at the Crossroads: Myths, Realities and Strategies for the Future," Zerhouni puts things in perspective. First, the current success-rate pinch is nothing new under the sun. Much as the business world experiences boom-bust cycles, NIH has faced disheartening times in the past. Quoting from a gloomy assessment of high competition for limited funds, and multiple disincentives to the research enterprise, Zerhouni challenges his audiences to identify the speaker and his era: it turns out to be former NIH acting director Dr. William Raub, speaking in 1982.

"This has happened before — in 1982, in the early 1990's and again now," Zerhouni observed. "History repeats itself. But NIH is strong, and our response to the current situation suggests we'll prevail again."

No budget forecaster could have foreseen the "perfect storm" facing NIH in 2006, he argued: deep federal and trade deficits, rising expenditures for homeland security, the economic — not to mention physical — devastation of Hurricane Katrina, preparations for potential pandemic flu, a 3-5 percent inflation rate in research costs that is outpacing the general inflation rate and an increased federal focus on the physical sciences. Added to these factors is a sense among some legislators that, having doubled NIH's budget, there's nothing more we really need.

As if this situation were not harsh enough, there are current myths about NIH's research priorities that Zerhouni took some pains to puncture: NIH is not emphasizing applied over basic research, though in 2002 and 2003 — owing mainly to biodefense needs and infrastructure build-up — there were bulky one-time expenses; NIH is not shifting toward solicited research (in 1994 about 91 percent of research project grants were unsolicited vs. 9 percent solicited, and today about 93 percent are unsolicited vs. 7 percent solicited); and the Roadmap initiative is not some roadhog eating up 30 to 40 percent of the budget, as Zerhouni has heard some folks theorize — the real numbers are about 0.8 percent of the budget in 2005, maxing out at around 1.5 to 1.7 percent next year.

 
Zerhouni shares a light moment at the NIA advisory council meeting with NIA director Dr. Richard Hodes (l).  
Furthermore, Roadmap expenditures aren't monolithic; in FY 05, there were more than 345 individual awards (at 133 research institutions), Zerhouni reported.

"Every great institution needs a little intellectual venture space," he said, where we can try new things that will benefit the entire research enterprise, and allow us to take risk for high impact. Far from having been concocted as a way of draining off R01 investigator-initiated grants, the Roadmap is largely an acceptance of recommendations from the Institute of Medicine and more than 300 representative scientists who contributed their opinions, Zerhouni reminded his audience. And even within the 1 percent of the budget it claims ("which really wouldn't buy that many more grants," Zerhouni noted), Roadmap expenses are 40 percent basic research, 40 percent translational and 20 percent high-risk (e.g., the Director's Pioneer Awards), the latter of which addresses long-standing concerns that NIH invests too timidly in research.

Audience Members React To Director’s Remarks

 
  Zerhouni makes a point at the NIA advisory council meeting.
There are few more critical audiences for an NIH director than the institute and center advisory councils, and the scientific societies, each of which is studded with opinionated members. NIH director Dr. Elias Zerhouni has been earning high marks with many owing to his frankness. “

I was impressed by Dr. Zerhouni’s presentation regarding the current status of NIH, particularly after seeing the facts regarding the research portfolio, including the funding of new initiatives balanced with continued R01 support,” said Dr. Mary J.C. Hendrix, president and scientific director at Children’s Memorial Research Center, Northwestern University, who sits on NHGRI’s council. “Furthermore, I have a better perspective now with regard to the global reality of our current funding situation and the strategies for the future. Without question, we scientists need to be more proactive in expressing our appreciation and need for continued support of the research enterprise.”

Observed Geoff Duyk, another advisor to NHGRI: “The director’s presentation provides important context for understanding the return on investment as well as the tangible benefits that have been and will be derived from the support of innovative health care research as a result of the growth of the NIH budget.”

Said Dr. Peter Spencer of Ohio State University, who serves on the NIEHS council: “The increase of 40 percent in the past 5 years in the cost of doing research suggests an unsustainable enterprise that will demand innovative solution, including increased outsourcing of research to less expensive parts of the world. I respectfully suggest this is a very important topic to debate in some depth at some future time.” He added, “The Roadmap was billed as 1 percent of the NIH budget, which is a correct statement, but this is 1 percent of the overall NIH budget, not the extramural program budget that university scientists focus on.”

Concluded another NIEHS council member, Dr. David Christiani, professor of occupational medicine and epidemiology at Harvard School of Public Health, who is also a professor of medicine at Harvard Medical School: “[It was an] excellent presentation by a very competent NIH director and advocate...we are in tough times, and Dr. Zerhouni discussed how we need to adapt. We stand to lose our world leadership in biomedical research; hence, the director needs to advocate,
with our support, for increased support from Congress, even (especially!) in tough times.”

Zerhouni said there are "three drivers behind the current sense of pain, and by far the largest ones are capacity-building, and the increase in tenure-track faculty." The doubling of NIH's budget prompted a building boom on extramural campuses. The increase in capacity was an appropriate response to the growing needs of medical research and public health problems. The difficulty now, however, Zerhouni pointed out, is that the timing of this boom is no longer concurrent with the availability of funds.

The issue of congressional appropriations is the second worry on the minds of NIH and its constituency, and is "a long-term issue," Zerhouni said.

The third main driver of the current crunch — and the biggest reason for declining success rates — is the dramatic upsurge in grant applications: almost the same number arrived in the 2 years following the doubling than occurred during the entire 5-year doubling process itself. "There is no magic or shadowy manipulation behind the current crisis — it's just supply and demand. Basically, the demand for NIH grants took off just as the budget was coming in for a landing. The two should be taking off together, not landing."

Zerhouni is assuring each audience that "we clearly understand the pain of supply and demand. We want to return to an era of reasonable success rates. Right now, we are in a period of readjustment." He also emphasizes that, although getting grants is more competitive nowadays, many more scientists are receiving funds due to the large increase in faculty at institutions. "More than 10,500 new applications arrived in 2005," he reported.

He offered a four-part prescription: know the facts; develop adaptive strategies (he emphasized the core mission of protecting knowledge and discovery, increasing the number of competing grants via management of supply-demand issues, and supporting new investigators through new programs such as the Pathway to Independence Program, thereby preserving the future); convey a unified message to the public at the local, regional and national levels about the benefits of medical research ("I've been very aggressive recently, and very explicit," Zerhouni said); and always emphasize NIH's exciting vision for the future.

"People not only support you for what you did," he explained, "but also for what they hope you will do."

In the next 15-20 years, he said, the paradigm in medicine will shift "from a curative approach to a pre-emptive one." He outlined the "four P's" that will characterize medicine's future: predictive, personalized, pre-emptive and participatory.

The last fact in his presentation put matters in perspective: the nation invests $95 per year, per person, on NIH science while the cost for health care per person each year is $7,000. "Unless we transform medicine through discovery, the game will be lost," Zerhouni concluded. "There is no better investment than biomedical research."

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