What happened to the enthusiasm for medical research that inspired Congress to heap rising billions upon the National Institutes of Health over many decades? Though multibillions are still forthcoming for NIH, making it by far the world’s richest biomedical enterprise, growth is gone, creating awful strains for individuals and research institutions. Even with all that money, financial insufficiency roils the system because in addition to staking scores of thousands of full-fledged researchers, NIH supports thousands of trainees, many of whom aspire to become grantees.
In step with this dynamic, Congress regularly raised the NIH budget, from $3.4-billion in 1980 to $13.6-billion in 1998. Then, in a burst of biomedical largess, Congress resolved to double the budget in five years — and did so, despite resistance from the White House. By 2003, the NIH budget topped out at $27.5-billion. Over half of all nondefense federal research money goes to NIH. A surge in grant applications ensued — a common phenomenon when research money rises — with the total doubling to nearly 80,000.
But since then, the budget has increased only a bit, rising to $28.9-billion in the latest outcome on Capitol Hill. Bio-purchasing power is in a slump, down 8 percent or more from 1998, by various reckonings. Gloom fills the halls of science, as the success rate for grant applications continues to nosedive. Congress has shown no interest in a bailout, despite warnings of scientific decline, loss of competitiveness, risks to health, and related misfortunes that kept the money flowing in past times.
A convergence of factors — some obvious, some not — accounts for the turnabout in Congressional sentiment. In 2003, Congress felt it had done well for NIH, and saw no need for maintaining the rapid growth. The costs of war impinged on all domestic programs. Concerns about economic competitiveness turned attention to the long-neglected physical sciences, which lost their premier place at the federal trough when the cold war ended. When the White House issued its American Competitiveness Initiative two years ago, increased support for federal research agencies was emphasized, but NIH was not on the list.
It’s likely, too, that Congress is suffering from miracle fatigue. Great promises of cures on the way have always enlivened biomedical politics, but the rhetoric hit new highs in the era of gene therapy — which continues to look promising, but has actually delivered very little to health care.
Another coolant for Congressional ardor was the touch of scandal at NIH, starting in 2003, with revelations of lucrative consulting deals between NIH administrators and pharmaceutical companies, tarnishing the halo of the revered temple of healing.
And finally, the roulette of Congressional committee assignments and seniority has not been favorable for NIH in recent years. Back in the golden days, passionate believers in medical science chaired the right committees and did missionary work among their colleagues in behalf of more money for NIH. Today, there are no such champions for Bethesda.
Given America’s yen for healthful long life, relief from pain, and medical miracles, the bleak times for biomedical research will surely end. But not soon.
