The NIH: A broken pipeline, yes, but the blame is not entirely on the NIH

As an NIH-funded surgeon/scientist, I just had to read this report at when I became aware of it, courtesy of Bora and Drugmonkey. Basically, it describes how bleak the NIH funding situation has become, particularly for young investigators. The report (PDF) comes from several prominent research universities and warns that we are at risk of losing a generation of new biomedical researchers. Even taking into account the knowledge that this report is anything but unbiased (indeed, it is explicitly in favor of increased NIH funding), the situation it paints is still pretty grim, and I can report to you honestly that I haven’t seen morale in academic biomedical research this low since the last time the funding situation was this bad, namely back in the early 1990s. Of course, back then I was a graduate student and had been savvy (and fortunate) enough to have latched on to a promising young assistant professor who was funded, but even then I saw long-tenured and productive professors having to shut their labs because they couldn’t renew their R01 grants.

This time around, I’m a principal investigator. I’ve gotten my first R01, but I’m approaching an equally important point in my career: Having to renew it for the first time. I was fortunate enough to be funded just before things started to take a real turn for the worse, just barely squeaking in under the wire, so to speak. Now I am nearing the end of the third year of a five year grant and wondering whether I will be able to renew it. The time to submit my competing renewal is only a year and a half away, and each and every day I wonder whether I’ve been productive enough and whether I can come up with a good enough proposal to continue the work to keep my lab going. Indeed, these quote from the report resonates just as much with me as it does with young investigators:

“Twenty-four hours a day, seven days a week, you’re thinking about your grant proposals and wondering how to survive in this world where fewer people are getting funded, and proposals that are funded aren’t being fully funded or are being cut.” Michael Rodriguez, M.D., M.P.H. UCLA

“The process of getting NIH funding can be a career in and of itself. It takes time, and you have to be persistent.” Kristen Newby, M.D. Duke University

One aspect of this report bothered me, though. Although holding the NIH budget flat or below inflation has indeed caused a serious problem, this report is very simplistic in that it doesn’t address the other side of the equation. Indeed, I wrote about this very aspect on more than one occasion (links at the end of this post).

What am I talking about? The universities themselves contributed to the very problem that this consortium is bemoaning.

Big time.

Why do I say this? For every dollar in grant money that an investigator receives, an additional 50 to 60 cents go to his or her institution to cover the “indirect costs” of maintaining laboratories and facilities and administering the grant money. Moreover, the investigator is expected to pay part of his or her salary out of the grants received, meaning that the university doesn’t even have to pay the entire salaries of its research faculty that are funded by NIH grants. Indeed, to receive tenure, a young investigator is generally expected to compete for NIH funding, preferably R01, and to cover at least 50% of his or her salary–or even more–from grants. It’s a huge gravy train for universities, and it’s not for nothing that both Abel Pharmboy and I have likened being a research in such institutions to being a freelance used car salesmen.

With that background, let’s go back in time to the golden era between fiscal years 1998 and 2003, when a bipartisan effort succeeded in nearly doubling the NIH budget. Paylines loosened up, and the spigot of money government money and its associated indirect costs seemed never-ending. Truly, times were good for a brief time. Unfortunately, two problems in addition to the flat NIH budget from 2004 (courtesy of the Bush administration and the war) on set the stage for our present crisis. The first was that there appeared to be little planning for how to cover the “out year” commitments of all these new grants being awarded. What many don’t realize is that a five year R01 grant is in reality five one-year grants. The money isn’t in a bank to cover the five years, each “out” year of the grant is covered from the NIH budget of each fiscal year the grant encompasses. If a grant is awarded in fiscal year 2008, for example, then it will in reality be five grants in FY 2008, 2009, 2010, 2011, and 2012. Even before the five year doubling was well under way, there was concern about preventing a “hard landing” in FY 2004, the first year after the doubling of the budget occurred and all those extra grants funded in the heady days between FY 1998 and 2003 were still on the books and had to be funded all the way through FY 2008. The concern, as experience shows, was justified. When the budget went flat and, adjusted for inflation, even started to decrease slightly, the result was predictable: The out year commitments from grants funded during the doubling started to squeeze out funds for new grants. Moreover, the NIH couldn’t save any of this windfall for a rainy day; by statute it has to spend its budget each year, as described in Science and Inside Higher Ed. The NIH did a number of things to try to keep the percentage of success from falling too far (cutting 23% off of the budget of my grant and those of many others right off the top and then cutting 2-3% per year), but that only kept the situation from becoming even more dire than it is now.

The second issue is the universities themselves. The doubling of the NIH budget led to a recruitment and building boom at research institutions all over the U.S., as universities sought to capitalize on the increase in the NIH budget. This led to a huge increase in the number of grant applications submitted to the NIH:

Meanwhile, research institutions everywhere were breaking ground on new facilities and expanding their faculty. In a 2002 survey, AAMC found that new construction at medical schools had exploded: From 1990 to 1997, schools invested $2.2 billion in new construction, compared to $3.9 billion from 1998 to 2002. But that paled in comparison to what was to come: an expected $7.4 billion in new construction from 2002 to 2007. AAMC has not yet confirmed whether these plans were carried out.

Schools hired new faculty members to fill the buildings, expecting to recoup their investments from the NIH grants investigators would haul in. “Universities and their leadership did what I would have done too,” says Zerhouni. “The government is indicating support for these activities,” and the expansion was “exactly what Congress intended.”

This appears to have helped drive more applicants to NIH. In 1998, fewer than 20,000 scientists sought research grants from the agency; in 2006, that number was more than 33,000, and according to NIH forecasts, the number of applicants is expected to top 35,000 in 2007. The number of applications has grown at an even faster clip, as scientists, concerned about their chance of getting funded, are submitting proposals more frequently. Because growth at medical schools lagged somewhat behind the doubling, many institutions are still expanding. At Sloan-Kettering, for example, officials only recently began filling a new building with scientists. They expect to increase their faculty by almost 50%, says Varmus.

But as requests for NIH money edged upward, NIH’s resources began to drop. After a 16% increase in 2003, the final year of the doubling, NIH received a 3% boost in 2004, an abrupt reversal of fortune. Although the general rate of inflation in 2006 was 3.1%, according to the U.S. Department of Commerce, the cost of goods and services in biomedical research and development rose 4.5%. The number of competing grants NIH funded peaked in 2003 and has been dropping since. The declining value of NIH’s dollars and rising demand were “a perfect double whammy,” says Zerhouni.

If anything, things have only continued to deteriorate since the above article was published.

I understand that the Broken Pipeline effort is an advocacy effort. I also largely agree with its report that the NIH is crisis right now because of five years of flat or declining funding. I also largely agree that much of the blame falls at the feet of the Bush administration. Oddly enough, the doubling of the NIH budget, started with such good intentions and fanfare, may have ended up hurting the NIH. It may well have been far better to have had a slower, more sustainable increase in the budget, rather than the boom-and-bust doubling that we saw. I too worry that the current funding climate is causing talented young researchers such as the twelve profiled in this report to consider other options and decide to do something else for a living, putting our future biomedical research effort and innovation at risk. Indeed, I can relate. I’m a surgeon. Unlike many Ph.D. researchers, if I fail to renew my grants I can always go back to taking care of patients and operating for a living. I’d view it as a serious career failure even though I’d probably make more money than I do now, but I could do it.

The problem with the Broken Pipeline effort is that it puts all the blame in one place. To wax Biblical, universities are pointing out the mote in the Bush administration’s eye and ignoring the plank in their own. An acknowledgment that universities share in at least part of the blame for the plight of the twelve promising young researchers profiled in the Broken Pipeline report would have made the Broken Pipeline effort more convincing–to me, at least. In its present form, this report strikes me as simply asking for more money to prop up a broken biomedical research system, with twelve talented young researchers used in much the way some charities use children with cancer to extract money from donors. Perhaps it’s time for a more radical change than just throwing more money into the same system. Sure, more money is clearly needed, but without systemic changes, how do we know we won’t be in the same situation five years from now?

We don’t.

Perhaps it’s time for some real reform. Perhaps it’s time to try to change the “used car salesman” model of how biomedical research is funded at universities.

Other posts:

  1. NIH grant funding in crisis
  2. Sweating to the NIH paylines
  3. Biomedical researchers at medical schools: Free-lance used car salesmen? Or: Show me the money!