Real NIH reform

A reader asks if NIH funds are really spent as efficiently as they could be. A short answer might be that nothing is perfect, but in fact people (including YT) have thought about this quite a lot lately. The House Committee on Energy and Commerce—chaired by former US Representative Cathy McMorris Rodgers (R-WA) — released a report in June 2024 entitled Reforming the National Institutes of Health: Framework for Discussion. The report recommended closer oversight of high risk research, including international collaborations, no doubt at least in part resulting from concerns about the Wuhan Institute of Virology, and genetic research in general. I can't argue with that, it's a legitimate public concern even if arguably a bit overblown. However, that would obviously cost money rather than saving any.

 

Other recommendations include limited leadership tenure, which is a somewhat complicated argument but I won't argue with it; and more congressional control over funding decisions, which I'm not crazy about but a congressional committee would say that. Not that congress would actually do it. They already do outline broad priorities for research and allocate funds among the various institutes and centers. 

 

Which brings us to the more consequential recommendation, which I do support. That is to consolidate the 27 institutes and centers into 15. It is a legitimate problem that the missions of the institutes and centers are siloed. For example, alcohol misuse, misuse of other drugs, and mental illness,  not including the previous two problems, are all addressed by separate institutes. Several institutes are concerned with specific body parts -- heart, kidneys -- or systems, e.g. the National Institute of Allergy and Infectious Disease can more or less be thought of as focusing on the immune system, while the National Cancer Institute focuses on innumerable diseases of abnormal cellular replication. 

 

If you know anything about physiology or public health, you can immediately see a problem, or maybe several. Humans don't consist of all these unrelated parts or sub-systems. We're all of them at once and they all go together. Hypertension damages the circulatory system and the kidneys. Among the causal factors are emotional distress and alcohol misuse, and those are all related to social determinants, some but not all of which are separately the concern of the National Institute of Minority Health and Health Disparities (uh oh, that's presumably going away entirely very soon). If I have a proposal to study primary care, or integrated behavioral health and medicine, or medical and psychiatric comorbidity, among a million other ideas I could suggest, I don't know where to send it. 

There are many additional ways in which the functioning of NIH could be improved, which I'll get to next. But the point is, people have been thinking about this and there are well informed, thoughtful and plausible proposals out there. None of them includes a chainsaw.