Republican Speaker of the House of Representatives Pushes for NIH Reform Proposal, Here Are the Problems

Cathy McMorris Rodgers (R-WA), chair of the House Energy and Commerce Committee, has done just that made a proposal for reform of the National Institutes of Health (NIH). The NIH is perhaps the most important health and science organization in the US. Since the NIH is the largest funder of biomedical research, what it does and how it operates will in turn influence scientists and scholarship across the country. This, in turn, will impact the health of virtually all Americans. The big question then is how much of this proposal is actually based on, you know, health and science versus politics.

That’s because a number of politicians have tried to politicize science to the extreme in recent years. So while many scientists and health experts may agree that the NIH needs significant reform, look skeptically at any reform proposal put forward by any politician, rather than from actual science and health experts. After all, would you watch a movie directed and produced entirely by politicians? Would you trust an Olympic team coached and trained entirely by politicians, rather than by people who, oh, play the sport themselves?

Which real scientists and health experts drafted the proposal?

Yes, a closer look at the “Reforming the National Institutes of Health, framework for discussionRodgers’ document shows little evidence that the proposed changes to the NIH come from actual science and health experts. In an op-ed published in STATRodgers, who is not a scientist, researcher, or health expert, and House Appropriations Subcommittee on Labor, Health and Human Services, and Education Chairman Robert Aderholt (R-AL), who is also not a scientist, researcher, or health expert, advocated for the proposal and wrote: “Our message to scientists, researchers, patient advocates, colleagues and the American people is simple: our door is open. Work with us. Be a partner.”

Um, imagine people building you a house to live in and then telling you, “Hey, we didn’t bother to ask your opinion when we were designing and building the house. But you are very welcome to work with us now.” Yes, that’s not the same as having the house designed and built from scratch. And how much certainty is there that they will even listen to your suggestions? Rodgers and Aderholt did not make clear which scientists and health experts they would allow as their partners and how.

What is the scientific rationale for the proposed new organizational structure of the NIH?

Rodgers’ document also proposes a major restructuring of the NIH—reducing the NIH’s current 27 Institutes and Centers (ICs) to 15—without providing much scientific support for the proposed realignment. For example, why does this new arrangement seem to put all other organs, such as the heart, lungs, and gastrointestinal tract, into a National Institute of Body Systems Research, while still keeping the brain and nervous system separate in a National Institute of Neuroscience and Brain Research? ? Anyone who has ever tried to hold back a fart knows that the brain is generally connected to other parts of the body.

Furthermore, the intended purposes of many of these new ICs are not very clear due to their rather ambiguous names. For example, it seems a bit strange to have a proposed National Institute for Health Science Research, since “health science research” isn’t something the entire NIH should be doing? It is not the case that the other institutes would conduct ‘stuffed animal scientific research’. The same goes for the National Institute on Innovation and Advanced Research. Does this mean that the other institutes and centers will support non-innovative and non-advanced research?

None of this means that the NIH doesn’t need major restructuring. Much of the basis for the NIH’s current structure came decades ago—in some cases, even before the 1970s, polyester leisure suits were popular. In the same way that adding fashion accessories won’t overpower the fact that you’re wearing a casual suit on a date, simply adding or tinkering with the current NIH structure may not solve the deeper problems with the existing structure. For example, keeping ICUs separated by body parts and certain diseases may continue to favor “I’m only looking at the back of the eyeball” silo approaches when more integrated systems approaches are needed. So yes, an overhaul of the NIH structure could be justified, but it should be done in a way that is justified by science and not political whim.

Will the proposed changes make it easier or harder for scientists to conduct research?

Ultimately, if you want good science to be done, you have to make it easier for scientists to do research. And this hasn’t happened since the 1990s, with the amount of funding allocated to the NIH each year barely keeping pace with inflation. That’s despite the fact that the population is growing in size and the cost of doing science is greater than inflation. NIH funding has become the lifeline for most independent biomedical researchers – independent means they don’t work for a company that sells certain products. Yet Rodgers’ proposal fails to recognize the fact that the relative shortage of NIH funding has made NIH grants much more difficult to obtain in recent decades.

Her proposal also does not address the increasing administrative burden that scientists face. There are probably very few scientists who, as a child, said, “I want to do science so I can fill out forms and attend meetings.” Yet Rodgers’ proposal introduces even more reporting requirements for NIH grantees without attempting to reduce the existing administrative burdens scientists face.

Then there is the declining job security for scientists who are often on a constant treadmill seeking funding to support their research activities and maintain their positions. Many academic and research institutions have moved to the ‘soft money’ model, where the moment you can’t raise enough external grant money is the moment you have no real salary. And having a paycheck is kind of important for food and stuff like that. If it’s easier to make money as a YouTuber or TikToker and sell things, guess which direction scientists and potential scientists can go.

Things would become even more difficult for scientists who have been very productive with Rodgers’ proposal to limit researchers to receiving no more than three active grants and awards from the NIH at a time. Ummm, it doesn’t work very well if you effectively tell successful people, “Yes, we don’t want you to be too successful.” If you want to provide more support to newer scientists, you can’t just divide the same pie in a different way. You need to make the overall pie bigger.

Moreover, Rodgers’ proposal talks about encouraging more innovation, but does not explain exactly how that will happen. That’s like saying, “You should really try to be attractive on a date.” True innovation brings freedom and resources when scientists feel freer to take risks and don’t have to constantly worry about things like finding funding and job security. You don’t say to someone clinging to the edge of a cliff, ‘Take the time to be innovative. Try something new.”

Finally, there’s the whole anti-science stuff that scientists are currently dealing with. With so much misinformation and disinformation about science out there and the heavy politicization of things that should be scientific issues, like climate change and Covid-19, the last thing you want is politicians deciding how science is going to be funded and conducted. Why don’t we let real scientists do that? Congress could task independent committees of scientists, health experts, and patient advocates to design and propose new structures for the NIH. These can be conducted in a transparent manner that allows for broader public input and demonstrates how such input is taken into account.

If you look back at American history, the original founding fathers of this country included scientists like Thomas Jefferson and Benjamin Franklin. The country’s rise to global leadership was fueled in large part by scientists (including many who immigrated from other countries) and scientific innovation. Likewise, whether America will grow or decline in the future will depend on what science is practiced and whether it is led and conducted by real scientists rather than politicians. After all, science isn’t something you can fake until you make it. And good science tends to build a nation, while the lack of science can tear it apart.