Clinical trials Medicine Politics Science

The NIH threatened

As most of you know, most of the basic and translational biomedical research in the U.S. is funded by the National Institutes of Health (NIH). Unfortunately, the NIH budget has been stagnant for the last five or six years. That’s been bad enough, leading to a decline in funding success rates for applicants for research grants to a low level that we haven’t seen in nearly 20 years. Worse, even though FY2011 started October 1, the federal government still doesn’t have a real budget. It’s operating on a continuing resolution. While this plays havoc with all government agencies, it’s particularly bad at the NIH, where funding levels have dropped to the 7th percentile or lower (7% of grant applications funded), because, not knowing what its final budget is going to be, the NIH gets very conservative, and there’s no guarantee that the funding will get better even once the FY2011 budget is finally passed. I experienced this very thing six years ago, when funding levels dropped precipitously from the 21st percentile to the 16th percentile, which should give you an idea how much the situation has deteriorated since then.

Isis sent me this message from Dr. William Talman, president of the Federation of American Societies for Experimental Biology (FASEB), about proposed spending cuts to the NIH budget. Please read it:

Dear Colleague,

For months the new House leadership has been promising to cut billions in federal funding in fiscal year (FY) 2011. Later this week the House will try to make the rhetoric a reality by voting on HR 1, a “continuing resolution” (CR) that would cut NIH funding by $1.6 billion (5.2%) BELOW the current level – reducing the budget for medical research to $29.4 billion!

We must rally everyone – researchers, trainees, lab personnel – in the scientific community to protest these draconian cuts. Please go to [this link] for instructions on how to call your Representative’s Washington, DC office today! Urge him/her to oppose the cuts to NIH and vote against HR 1. Once you’ve made the call, let us know how it went by sending a short email to the address provided in the call instructions and forward the alert link to your colleagues. We must explain to our Representatives how cuts to NIH will have a devastating impact on their constituents!


William T. Talman, MD
FASEB President

If you have a blog, blog this. Call your Representatives. As P.Z. Myers and Paul Krugman put it, we’re eating America’s seed corn in science, and there will be a steep price to pay someday. Worse, in the scheme of things, the savings are minimal and symbolic. The real problem is entitlements and defense spending, and with those off the table, all we have left is nonsense like this. The bottom line is that all the changes in peer review, whether to allow two grant application resubmissions instead of one, won’t make one whit of difference when funding levels fall this low.

But it’s worse than that. It’s not just the NIH. It’s nearly every major government science agency, and, because the cut would come in the middle of the year, after half of the budget has already been spent, these proposed cuts are in essence double the numbers. At least, that would be the effect:

But, we’re half way through the fiscal year, so almost half that money is already obligated, so we’re looking at more like 30-40% cut from the remainder.

That means NO NEW MONEY going out, including grants that have been approved but not sent out.

Further, it really means rescission and clawbacks – taking back to the agencies funding already disbursed.

I know Congress can be short-sighted, but what the House of Representatives proposes to do is astonishing for how much damage it would do for so little budget savings.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

26 replies on “The NIH threatened”

Perhaps we can make NIH “real” to them. Many in the House are elderly and have health problems. Show them how the NIH has contributed to the cures and treatments they’re now taking. It isn’t just some sciency thing wasting money, but doing actual research that can pay off now and pay off later, and give examples, as many as many as we can.

Meanwhile a modest cut to enlisted personnel here in the Marine Corp is greeted with the standard jarhead bullshit and renewed calls for republicans to be put in power. I wish I could see a light at the end of the tunnel but this is shaping up to be one ‘interesting’ century.

I would much rather see NCCAM cut out of the budget. NCCAM is nothing but a waste of time and the taxpayers money.

The problem stems from the fact that people see “science” not as a process for acquiring knowledge and information about the world and ourselves, but as some sort of elitist country-club for ineffectual intellectuals to tinker with minor experiments, all while making a fortune off the public dime. Science the pursuit needs to be separated from science the institution (I hope that made sense, I’m writing this just after waking up).

The other issue is that research is such a long-term investment, and if there’s one thing we’ve seen, it’s that America hates waiting. Try explaining how an investment in a researcher studying a ribosomal subunit binding system in a certain cell line could, 20 years down the road, lead to another treatment for cancer (and not a CURE, like your friend has written about elsewhere).

This continues to be worrisome.

The stimulus package boosted NIH funding slightly back in 2009. I remember Hannity running a segment about wasteful stimulus spending and several of the things he targeted was “wasteful” studies done by the NIH. In particular, he mocked a primate study being done on cocaine addiction research. He said something ridiculous like “what can we learn from monkeys!?!?”

I’m not trying to get political here, but I think this represents a lot of the public and how they misunderstand what the NIH does, how science works, etc. The studies are seen as wasteful. Doctors and scientists are seen as overpaid. It’s unfortunate.

@ Mandos:

Social Security, Medicaid , unemployment, Medicare. These constituted 57% of 2010 spending, and are expected to increase dramatically in coming years (Medicare especially). Besides entitlements, defense covers 15%, interest on the debt 11%, and all non-defense discretionary spending combined 16%.

That’s why Orac correctly characterizes these cuts as “minimal and symbolic.” When all the money goes to entitlements and defense, that’s where cuts have to happen.

See in particular page 119.


It’s tough to judge a study from how Fox portrays it. The one in the article’s title is very important — what are the barriers to condom use? I mean, sure, we can all laugh and make jokes about it — “it’s because guys don’t want to use them, cuz, you know, it’s *better* without them” — but this is actually a serious issue. Unwanted pregnancies and the spread of STDs are both facilitated by insufficient condom use. This part is obvious, yes, but that’s not what the study is about; it’s looking at all of the reasons many men don’t use condoms as much as they should and working out which ones would be easiest to attack. Infantile joking aside, any discomfort would greatly reduce the willingness of a man to use one, and that’s a specific thing they’re studying. If it can be fixed, a huge amount of money could be saved by not having to treat as many STDs and not having as many babies on welfare or food stamps or whatever.

The studies listed in the article all seem like “well, duh, they do that because they’re IDIOTS!” but if it were that easy, these problems would not exist. Solving them does require understanding them better. Of course, maybe whoever wrote the piece thinks they’re still wasteful because he/she doesn’t think these problems *deserve* solving. But that’s a different problem.

@ Michael:

Besides Callie’s excellent points, let’s assume (at least for the sake of argument) that there are wasteful studies performed. Is the solution to that to cut the NIH’s funding? No; that will cut valuable studies too. To a first approximation, one might assume that wasteful and valuable studies would be cut in equal proportion. After all, it’s not like the NIH agrees that they’re wasteful and they’d therefore be the first ones cut – if the NIH shared that opinion, they’d not have been funded at all. It’s not like there’s a shortage of clearly valuable projects to spend the money on!

No, the solution to wasteful study funding would be improving the processes for allocating said funding. Using that as a rationale for reducing funding overall is cutting off your nose to spite your face.

@bluedevilRA – ARRA didn’t boost it slightly, NIH got $10 billion over two years, compared to ~$30 billion/year as its baseline.

@Happy Camper – NCCAM’s budget is less than $150 million. NIH is facing cuts from the house of over $1.6 billion.

Great points all around. I know its tempting to dismiss the studies as silly. Anytime I see a headline that says “Exercise and healthy eating lowers (insert disease) risk” I tend to roll my eyes because it seems so obvious. But the reality of it is, we need to study these things. If we do not actually show that exercise helps with a specific conditions, then we cannot continue to claim it does.

I guess my point is that what seems obvious to the public has not always been proven. It is the NIH’s job to figure these things out through studying them. They need funding to do this. Are there bad studies? Of course, but funding is extremely competitive (as any investigator knows) and that alone serves as a way of weeding out potentially wasteful studies.

CAMP LEATHERNECK, Afghanistan — The U.S. military is applying an ancient Chinese healing technique to the top modern battlefield injury for American soldiers, with results that doctors here say are “off the charts.”

“Battlefield acupuncture,” developed by Air Force physician Col. Richard Niemtzow, is helping heal soldiers with concussions so they can return more quickly to the front lines.

I hope you can all see that this is just an area that affects you, so now you are paying attention. Did you vote in the mid terms? Did you actively work for your candidate? Like it or not, this is political and the crazies got the majority.

By the way, it’s important to note that Social Security is an insurance program NOT an “entitlement”. You get what you pay in, not government or taxpayer largesse. Do we really want Medicare “on the table”? Talk about a slippery slope! Do you want loons who have no regard for science messing up Medicare? We should be seriously considering Medicare for All, not dismantling it.

Defense is the place we could do some serious surgery. How about closing bases in Germany and Japan? Or here for that matter.

Science is easy to pick at–who is going to holler but a few “eggheads”? Scientists need to get involved long before the hatchet starts to fall.


Do you have data on how much money the typical Social Security recipient contributes over a career vs. how much they withdraw in retirement?

By the way, it’s important to note that Social Security is an insurance program NOT an “entitlement”. You get what you pay in, not government or taxpayer largesse.

False; the bulk of Social Security taxes are used directly to pay benefits to current retirees, not saved. The whole “trust fund” concept is nothing more than an accounting gimmick – one part of the government owing money to another part. Bottom line, taxpayers are on the hook for the payments.

Do we really want Medicare “on the table”? Talk about a slippery slope! Do you want loons who have no regard for science messing up Medicare?

Given how expensive it’s going to be getting in coming years, Medicare HAS to be on the table. There is simply no alternative to somehow limiting that spending.

We should be seriously considering Medicare for All, not dismantling it.

Dismantling != limiting the costs of.

Social Security, Medicaid , unemployment, Medicare. These constituted 57% of 2010 spending, and are expected to increase dramatically in coming years (Medicare especially). Besides entitlements, defense covers 15%, interest on the debt 11%, and all non-defense discretionary spending combined 16%.

As a point of comparison, the figures for the EU-27 public spending in 2008 were (Eurostat, table gov_a_exp) 53½ % on health and social protection and 3.2 % on war.

It should be noted that these are not directly comparable, because I used total government expenditure, whereas the commenter I quoted referred to only the federal expenditures in the US. But 57 % on “entitlements” does not sound like it is in the wrong ballpark for a mature industrial democracy. And even if we suppose that the US states have no military expenditure, and that their spending is as large as that of the federal level, you’ll still end up with something like twice the European ratio of war expenditure to total sovereign outlays.

– Jake

@ Jake:

Invalid comparison. For the EU-27, the bulk of health spending is by the government; for the US it’s by private insurance. So you can’t just compare the budgetary figures. Government spending also is a larger fraction of the economy in the EU, in significant part due to exactly the same effect; this also defeats such comparisons.

The proper comparison would be a sum of all health and pension spending, public and private, as a fraction of GDP.

On one hand, the NIH cuts feel like we are eating our own seed corn.

However, economically, the US needs to radically improve health care results, cut costs at home, and export lots of new, expensive stuff abroad. These goals conflict to varying degrees.

The US’ looming economic constraints seem compelling. We, as a country, may well face a perfect storm that renders this current discussion a farce.

I have wandered through cold, cavernous, empty Soviet research institutes before. These obviously faced their funding and performance issues without success. Are we in a similar boat?

We may wind up having to unpleasantly decide the most basic level of public health support. What should NIH be doing now, while it can, before some Deluge?

@13 if a single corpman comes near me with some ‘ancient chinese remedy’ I’m jamming his needles thru his skull.

Besides the direct effect of not funding particular studies with the potential for useful results, once funding gets this scarce it may end up defunding entire laboratories. I know some bloggers think this is a good thing–weeding out the labs with lesser fitness–but when 93% of proposals are not funded, I doubt that only the crummy proposals for marginal science are being cut out. Once someone loses all their funding, then they are likely to lose lab space because the university isn’t getting its share of overhead. Then how do they get preliminary results for new grant proposals to try to get back in the game in future grant cycles?

It’s the “airport bookstore” model of scientific research. Only the top few researchers deserve to stay in the business; the mid-listers doing solid but unexciting work can stop wasting our time.

Invalid comparison. For the EU-27, the bulk of health spending is by the government; for the US it’s by private insurance.

Yeah, but the insurance parasites don’t actually contribute to health care at all. If it weren’t for the hugely inefficient system of private health insurance – if you could get to, say, German or Swedish efficiency in the allocation of money – total costs would be comparable to what you currently spend in government outlays alone. The private part of your health service is little more than a subsidy for downtown Manhattan.

Government spending also is a larger fraction of the economy in the EU,

I wouldn’t be so sure of that, actually. In the EU-15, certainly, but EU-27 includes a large fraction of Eastern European countries that got the IMF treatment when the Warsaw Pact collapsed. Poland and Hungary, to take just two examples, have been run by Reaganists on steroids for the last twenty-odd years, with predictably sad consequences for their economies and public sectors.

But even if true, it just means that the US figures originally quoted would overstate the impact of public health and social protection on the American economy.

this also defeats such comparisons.

The proper comparison would be a sum of all health and pension spending, public and private, as a fraction of GDP.

Well, yeah, but this was the data I had on hand or could easily acquire, and it suffices for a ballpark figure. I am not adequately familiar with US databases to launch into a full comparison. And the federal budget outcome is largely irrelevant to the sustainability of US policy anyway, so it wouldn’t be worth the bother even if I had the time and inclination. (The US does have a deficit problem, but it’s in the trade deficit, not the federal deficit, and it’s caused by favouring the financial over the industrial sector, not by federal profligacy. The federal deficit doesn’t really matter under the post-Bretton Woods floating-rate ForEx regime.)

– Jake

It’s not the cost of Medicare that is the problem, it’s the cost of medical care. The cost of medical care inflating at double or triple or more than the growth of wages is simply not supportable for long. No amount of tinkering with Medicare will address the real issue.

Fixing the long term costs of Social Security is a trivial exercise. Currently, excess SS taxes help mask the true size of the deficit.

Getting out of Iraq and Afghanistan will help, but if we leave them unstable, we’ll be back again in a generation (or the problems there will come back to bite us at home).

Trying to reduce the deficit by reducing non-defense discretionary spending is pointless. It’s like cutting off your internet service while still not being able to pay the mortgage. Sure, some cuts are probably in order, but their needs to an accounting for the long term effects (don’t count on that, though).

Of course Republicans won’t talk about increasing revenue because they are strictly dogmatic (ie not grasping reality) on taxes. Getting the economy moving again will ease the deficit as well even with the current tax rates, but that might increase Obama’s chances of re-election. Boehner stated his top priority is ensure Obama is a one-term president (he’s since tried to backpedal by calling it his top political priority, whatever). Republicans don’t wan’t the economy to improve for the next two years because deficits and unemployment will stay high and they’ll improve their chances of taking the White House and Senate. Meanwhile, they can chest thump about cutting programs they don’t understand/disagree with.

You are making the dubious assumption that you’ll have the capacity to project power into Mesopotamia and Central Asia a generation from now.

That’s only true if you start scaling back your overseas empire. You can’t hold what you have now, given the energy situation and the industrial base you have left after three decades of thirdworldization. You can draw down your overseas deployments on your own time table and in good order, or you can wait until the empire collapses pell-mell on somebody else’s time table.

Your pick, but as a concerned citizen of the world I know which option I’d prefer.

– Jake

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