AAMC Reporter: July 2006

Viewpoint: "Strategic Weathering of a Perfect Storm"

Elias A. Zerhouni, M.D., Director, National Institutes of Health (NIH)

Scientists inside and outside of NIH are very concerned about the decreasing success rates for research grant applications. Many in our community as well as in Congress and the administration express disbelief about the apparent paradox of greater difficulties in obtaining research funding today as compared with before the NIH budget doubled. I want to share with you my perspective and the ways NIH is responding to these challenging times.

Faced with growing national health challenges, Congress and the administration substantially increased the NIH budget beginning in 1999 to stimulate research and innovation in the biological sciences. In response to these needs, U.S. biomedical research capacity has greatly expanded, and recent scientific advances present unprecedented opportunities for progress. AAMC institutions have invested over $15 billion in research facilities after 1998 as compared with $3.2 billion between 1990 and 1998. Consequently, there has been marked growth in grant applications at NIH.

However, because of the lag time necessary to build facilities and recruit faculty, most of the growth in demand occurred after 2003, when increasingly severe federal budgetary constraints limited budget growth. By 2007, the number of competing applications per year is expected to be twice the number received in 1998. With the average cost of grants up by over 40 percent since 1998, it is clear to see the origins of the current crisis. Even though the NIH budget doubled nominally, its inflation-adjusted purchasing power did not grow sufficiently to keep up with the large increase in grant demand made necessary by the complexity and scope of modern science. Some have suggested that major shifts in the portfolio of NIH toward solicited awards and away from basic science through the NIH Roadmap are the root causes of declining success, but this is inaccurate.

Aware of the accelerating demand for grants, NIH has worked to develop strategies for the post-doubling era. I have emphasized the following principles to guide our decision making. First, we must remain true to our core values and central mission: discovery and fostering the generation of new knowledge for better health. Second, as in the old proverb "never eat your seed corn," we need to protect the future by helping new and promising investigators. Third, as in any crisis situation, the key to success is to manage the few factors that account for the main stress. This means primarily managing the relationship between supply and demand of investigator-initiated grants.

We share the pain of seeing good scientists and ideas go unfunded and will make every effort to maintain a reasonable chance of funding for individual applicants. I believe that our portfolio of research should remain balanced in favor of investigator-initiated research, but it is also important to promote the development of new research opportunities and address pressing public-health challenges.

I will continue to make the strongest case possible for sustained support for NIH. I recently testified before Congress about the enormous return on the investment in NIH for the public. I showed, as just one of many examples, that our cumulative 30-year investment per American in heart disease research was about $110, or about $3.70 per year. This research has led to a 63 percent decrease in mortality for coronary disease and averted early death and disability for hundreds of thousands of individuals per year with an economic return estimated at over $2 trillion per year. I have asked NIH staff to focus on objectively demonstrating to the public the value of the NIH budget increase. All of us need to communicate more widely with the public about the value of NIH at local, regional, and national levels.

We need to point out that the NIH budget is not just another federal subsidy but a true co-investment with non-federal institutions that have taken the risk of building research facilities and developing their talent pool with local and state resources. This historic partnership has made the United States the most competitive nation in all aspects of the life sciences. Through our research, many communities have created new jobs and valuable economic enterprises.

Despite these past successes, NIH needs also to have a compelling vision for the future. I believe that we are in an era of great scientific opportunity and on the brink of transforming medicine and health in the 21st century through discovery. Our hope is to usher in an era where medicine will be more predictive, personalized, pre-emptive, and ultimately more efficient, thus reducing the growing burden of health care.

Great institutions are defined by how they navigate through difficulty. In these challenging times, it is crucial that we communicate more effectively with one other, with our scientists, and their institutions — and, most important, with the public. As NIH has done in the past, we can and we will weather the current challenges and continue to advance the science that is urgently needed to improve the health of the nation.

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