The NIH is Being Slashed and Burned, not “Reformed”

A strong and well-argued rebuttal to NIH criticism

Sensible Medicine continues to encourage criticism of our viewpoints. Vinay Prasad wrote recently that cutting NIH funding was Sensible Medicine. Dr. Leslie Bienen offers this rebuttal. It is an excellent read. JMM

By Leslie Bienen

Since the NIH order on February 7^th capping indirect funds to grantees at 15%, the “outrage machine” that is X is filled with mostly fact-free criticisms of the NIH and academic research. I explain here why I think the criticisms are flawed, and why a blanket 15% cap is a terrible idea.

Any cap should be blocked because only Congress can legally change NIH funding formulas.

On February 21^st a federal judge extended a temporary stay of the February 7^th policy, as she should have. Many have debated the “right” number for capping indirect rates and whether it is 15, 25% or some other number. But few mention that the current cap is illegal. In 2017 Trump similarly tried and failed to impose a 10% cap on NIH indirect rates, and Congress responded with several appropriations bills specifying that only Congress can change formulas for determining indirect costs. Several lawsuits detail why NIH can’t change indirects itself, including that “Congress exercised its constitutional power of the purse and forbade the executive from expending appropriated funds” and that “the Guidance does not even acknowledge the statutes that expressly prohibit NIH from taking this step.” If Congress wants to change the cap, let them do it legally.

Claims that 1) NIH funds mostly weak research, 2) cutting budgets will reduce the amount of weak research funded, or 3) NIH spends lots of money on DEI trainings are unsupported by evidence.

1. Finding a weak NIH-funded study and tweeting it does not prove that NIH funds mostly bad research. I can cite thousands of examples of excellent research funded by NIH—which would also be cherry picking. We do not have robust analyses of quality of NIH-funded studies or reliable metrics to assess strength of a funded study. In short, no one knows how much of NIH-funded research is weak.

2. There is no evidence that changing the amount of money dispensed will magically change how good the funded research is. We could end up with little research funded, all of it weak. To improve quality of funded research requires changing criteria or creating mechanisms that prioritize innovation, or replicability, or creating more randomized trial mechanisms.

3. The NIH data book shows exactly what the agency spends its 47B budget on: ~ 60,000 research grants plus intramural research and R and D awards and research centers. In 2023 approximately 3.3B went to “other” or “trainings”, or ~7% of the total. About 22% went to running the NIH (study sessions, salaries, etcetera).

The idea that universities are not “accountable” to the NIH for how they spend money is incorrect.

Universities cannot spend indirect funds on anything they choose; the list of expenses is approved by the government and is renegotiated every few years. I have written thousands of pages of budget reports to NIH and in my experience, money, including salary money, is extremely closely accounted for. In addition, universities already prohibit luxury expenditures such as flying first class, as does the NIH, which requires medical waivers to fly Economy Plus.

If Congress places an overall cap, it should be higher than 15%.

In 1994, the Federal government capped administrative rates at 26%. That cap is still in effect. What fluctuates per university is the rate that goes to facilities. If universities spend more of their own budget on facilities devoted to research, then their facilities rate rises, in order to incentivize university spending on research building and equipment. This is why large wealthy research universities (somewhat counterintuitively) tend to have higher indirect rates than state universities that build fewer labs, e.g., or buy less new equipment.

To understand why 15% will result in major reductions in research, take Harvard’s rate of 69% as an example. Their facilities rate is 43% and the administrative rate is 26%, equaling 69%. The new 15% cap would include both those numbers. Thus, Harvard would now have 21% of the money for research they had with a 69% cap. Jeffrey Flier, former Dean of Harvard Medical School, estimated this as a loss of ~$70 million at Harvard’s current level of NIH support. For many universities, even wealthy ones, this size budget hole is unfillable without significantly reducing research.

Lower-endowment state universities will suffer disproportionately.

Big state universities such as UCSF, Univ. of California, Berkeley, University of Illinois, and UCLA will be the hardest hit by lowering indirect rates so steeply. Smart policy reforms at NIH should protect state university research programs because they allow lower-income students access and exposure to careers and top scientists. Many of these universities are located in the South and Midwest and are vital to local economies and bring clinical trials and high-tech research labs which provide cutting edge health-care in places that would otherwise not have it.

These cuts will undermine the US’s position as the dominant world leader in biomedical innovation.

The USA is a global leader in biomedical research, partly because the NIH is the largest biomedical research funder in the world and a substantial percentage of biomedical innovations emerge from academic research. A 2020 analysis found that academic researchers contributed to 37% of cancer medicines discovered from 2010-2019 and 29% of antiviral drugs such as for HIV and hepatic cancers. The National Science Board reported that half of basic research in the USA is done in universities. A 2022 report from the Biotechnology Innovation Organization noted academic patents alone contributed $1.9 trillion and 6.5 million jobs to the US economy. The NIH estimates its 47B budget generates 97B to the US economy. Claims that this number could be higher are not supported by evidence and do not negate that 97B is a lot of money.

There is evidence, however, that the US is slipping as a leader in biomedical research. China now leads the world in new patents for pharmaceuticals. American scientists have been awarded 106 of the total 229 Nobel Prizes in Medicine or Physiology since the prize’s founding in 1901 but the UK now leads the world (31 total) after correcting for population. We should be shoring up our position not cheering as it plummets.

Arguments that these chaotic and destructive changes will lead to a future better NIH are unconvincing given how changes were accomplished.

It would be possible to improve the NIH, and research quality, without gutting academic research or laying off 1800 people solely because they were recently hired or promoted. Instead, the last few weeks’ chaos will make future meaningful reform more difficult as Dr. Jay Bhattacharya, whom I have worked with and greatly respect, will now inherit a demoralized and haphazardly reduced workforce. The recent layoffs are also penny wise and pound foolish as mostly younger and healthier people, the cheapest to employ and insure, are now gone.

It is hard not to conclude that these changes were a slash and burn operation or, more aptly, an operation to remove a nose to spite a face. Sadly, the face that is being spited is the American public’s and, to the extent that American innovation drives global biomedical research, the world’s.

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Leslie Bienen is a veterinarian, writer, and editor who researches and writes about disease, health policy, and topics that catch her fancy. She has published in The Atlantic, The NYT, Slate, USA Today, UnHerd, City Journal, Persuasion, WSJ, and elsewhere. Here is a link to her Substack.

She reports working with academic scientists across many disciplines on grants to federal agencies and philanthropic organizations.