NIH -- continued

Okay, I've summarized what a congressional committee has recommended for NIH reform. I endorse some of it and won't bother to argue against the rest. However, there is much they have overlooked. I'm taking the numbers I'm about to present from Rochelle and Loren Walensky, "U.S. Science in Peril," published in JAMA on February 14. It's subscription only, and there's no abstract, so you'll just have to trust me on this unless you have a subscription.

 

NIH uses various so-called "funding mechanisms," with designations such as R03, R21, R01, U24 and so on. Most are grants for single studies -- those are the R grants -- and the numbers basically distinguish how large they are and whether they're for preliminary and exploratory work, or a substantial hypothesis based study. U and P grants are for programs of research incorporating multiple studies, typically with "core" resources such as analytical or laboratory support. K awards are for post-doctoral research and mentorship. All of these are essential components of the scientific infrastructure.

 

The R01 is the substantial grant for a study for which preliminary work may already have been done using an R21 or the like. In 2023, NIH reviewed 48,660 R01 applications and funded 9,632 of them, i.e. less than 20%. These applications are extremely complex and laborious to prepare -- it typically takes months of work by investigators and administrators to put together the application package, which is hundreds of pages long. And the only way to pay for this is through the indirect costs the institution is receiving for projects that are already funded, and what are essentially unpaid hours for investigators. Oh, and BTW full-time tenured and tenure track professors are paid less now than they were in 1970, on average, and it isn't a whole lot for somebody who has 20 years or more of education -- about $100,000/year. 

The maximum budget for an R01 is $500,000/year, unless you get special approval, which is rare. That amount hasn't changed since 1993, meaning that adjusted for inflation it's worth 57% less. On average, scientists don't get their first R01 until they're in their 40s. Even if your R01 application is approved on the first submission, which is quite rate, it's ten months before the money comes. If you have to resubmit, which is almost always the case, it's another year and a half before you have a chance of seeing the money.

 

The Walensky's also aren't totally happy with peer review:

As for peer-review systems in general, gaps in reviewer expertise can lead to scientific misunderstanding, while conflicting feedback hinders the capacity to respond effectively; limited reviewer accountability allows inconsistent or unjustified critiques to undermine worthy grant applications. These systemic issues can slow scientific progress, discourage young investigators, and limit innovation.

In my experience, this is certainly true. There are three written reviews for each submission. The reviewers often contradict each other, and lack expertise to properly understand the proposal. They may also see a proposal as competition for their own program of research and downgrade it to protect their domain, or perhaps a junior faculty mentee; or they may belong to an opposing theoretical school. 

The Walenskys also complain about the shifting priorities that come with each new administration, and various other problems. The benefits to society of NIH-funded research are extraordinary. HIV used to be a sentence to a horrible death, now it just means taking a pill every morning and getting on with a normal life. The same was once true for pediatric leukemia, which now has a 90% cure rate. These are just two examples plucked from what could be a 100 page catalog. The solutions to these problems do not include reducing indirect cost rates or terminating programs of research that conflict with Robert Kennedy Junior's delusions. 

 

Actually they require more money, not less, but changes to the peer review process and simplification of applications are also needed. However, the people currently in charge have no understanding of how NIH and the institutions it funds work, the importance of what they do, or anything having to do with biomedical science. They are incompetent ideologues. So call your representatives in congress and tell them that they must protect NIH, AHRQ, the National Science Foundation, and all of the federal support for science.