The NIH Needs Reform: Here are 10 Sensible Suggestions
It is my pleasure to introduce this article by Joseph Marine, MD. Mr. Marine has 10 sensible suggestions for reform at the NIH. I love them all, but particularly #3, 6, and 8, which I have railed about for years.
Vinay Prasad, MD MPH
The NIH needs reform
The recent news that Dr. Jayanta Bhattacharya is being considered for the post of Director of the National Institutes of Health (NIH) was received with enthusiasm by many of us who opposed the US pandemic response. Jay, a Professor of Medicine, Economics, Heath Research and Policy at Stanford, was a primary author of the Great Barrington Declaration (GBD) and a consistent and articulate opponent of unscientific, harmful, and ineffective covid policies. He is a courageous, thoughtful, and deeply humane person who would make a great leader of any of our US public health agencies. Being appointed to lead NIH would be particularly fitting, given that the prior Director, Dr. Francis Collins, infamously tried to undermine him as a “fringe epidemiologist” for his support the GBD. While the report has not been confirmed, and he may be chosen to lead a different agency, here are a few sensible suggestions for NIH reform to consider:
1. Term limits of 5-10 years for all institute directors. The NIH can’t afford to have any more Faucis exercising control of entire fields for decades. While advocates might point to the political clout he exerted to increase funding for infectious disease research, this influence can lead to distorting of funding priorities away from public need and tunnel vision in the direction of the institute. Long tenure of office with control of a large budget can lead to corruption and accumulation of too much soft power. Regular turnover of leadership brings in fresh ideas and healthy change in direction and priorities.
2. Direct more funding to research in primary and primordial chronic disease prevention. A foundational principle of the Make America Healthy Again (MAHA) agenda is that the US spends too much on “sick care” that benefits corporate interests and too little on understanding and preventing chronic disease, which benefits the public. The public voted for this and the NIH should listen. Preventing more disease is a good use of public money.
3. Reduce and provide greater transparency on financial conflicts of interest. While we can recognize the potential benefit of financial incentivization of medical research, the fact that NIH and individual scientists received millions in royalty payments from an mRNA vaccine manufacturer, even as NIH leaders were promoting their vaccine technology as the primary solution to the pandemic, was a very bad look and undermined public confidence in both the vaccines and the NIH. Every doctor has to report comparatively trivial payments on every talk and manuscript for 1-2 years and the public can see all financial relationships on the Open Payments website. The NIH should provide similar transparency.
4. Consolidate the number of institutes and streamline the bureaucracy. The NIH started as a single institute and has grown to 27 separate institutes, each with its own bureaucratic silos. Just as academic divisions and departments are being reshaped into more consolidated institutes based on more modern understanding of disease processes and synergies, a more rational reorganization of the structure of the NIH is likely overdue. There are probably many outdated rules and regulations that could be reformed.
5. Make it easier to dismiss employees for incompetence and malfeasance. This a general problem in government and it leads to much of the dysfunction and lack of public responsiveness that we see. As far as anyone can tell, no one has been fired from the CDC for their production of a flawed test for SARS-CoV2 in February 2020. The shocking Congressional testimony of NIAID scientist David Morens in May 2024 has brought this issue into sharp focus and raised ire among lawmakers and the public.
6. Greater restriction on and oversight of use of mammals for research, particularly dogs, cats, and primates. The public has developed greater sensitivity on this issue, especially after revelation of the infamous beagle-sandfly experiments and the NIAID’s attempt to cover-up its involvement.
7. Require each institute director and every grant recipient to write and post an annual letter of appreciation. This letter should be addressed to the American public, thanking them for funding their work and briefly describing how their research benefits the health of the public. This policy would have the salutary effect of reminding researchers sponsored by the NIH where their support comes from and would help to educate the public on the important work that the NIH does on their behalf. Researchers supported by private philanthropists and foundations regularly provide this kind of feedback to their donors. The public deserves the same courtesy.
8. Bar all institute directors from participation in public health policy creation or advocacy. I highlighted in a prior Sensible Medicine post the potential chilling effect of institutions making policy pronouncements. Similarly, when an NIH institute director publicly supports a particular health policy, a present or future grantee of that institute is unlikely to publicly contradict it. This will inhibit open scientific debate on important topics and promote groupthink and illusion of consensus. This almost certainly happened during covid. Almost no one in the infectious disease or public health community was willing to publicly contradict Fauci or Collins, who then falsely claimed that they spoke for the medical scientific community with a unified voice.
9. More decentralization and depoliticization of research funding priorities. For example, the NIAID receives almost twice as much funding as NHLBI, even though heart disease kills far more people in the US. These disparities likely reflect political and personal influences rather than a rationale measure of public need. Involving more of each medical scientific field and the public in establishing research priorities, rather than a top-down approach, is more likely to meet the needs of the public.
10. Hold the NIH accountable for results. The US spends $4.5 trillion on healthcare and about $100 billion on publicly-funded biomedical research, yet the US does relatively poorly on many measures of health and some are actually getting worse. The NIH and recipients of grants should be measuring success not by how much money is spent by how much knowledge, health, and public benefit are generated.
The common theme in all of these proposed reforms is that the NIH, which was established as a public health agency, should be more responsive to the US public across the political and ideologic spectrum. During the pandemic, their leadership exhibited a sense of entitlement, grandiosity, and self-importance that is unhealthy for the NIH and academic medical culture generally. The NIH is an important institution which has supported critical research that has advanced human health. A fresh perspective is sorely needed to address the roots of the US chronic disease epidemic and restore public trust in the NIH and other health agencies.
I welcome feedback from the readers of Sensible Medicine. What NIH reforms do you think are needed?
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Agree completely. Here's more on point 8. "Bar all institute directors from participation in public health policy creation or advocacy.".
There are no elected positions in any of the PH agencies. Hence, accountability is only an indirect path through the president. The result was that Fauci, Collins, CDC Directors, etal, can make unjust pronouncements of enormous impact on our lives, arbitrarily and with impunity. To start a long list, think school and business closures, the six-foot distancing rule, masking and vaccine mandates.
Technically, these pronouncements mostly don't have a statutory basis. This falls to state public health agencies who have actual authority on most PH rules and enforcement. And in some cases, the president issued executive orders.
Hence, Fauci can later claim "I never closed any schools". https://fee.org/articles/fauci-claims-he-had-nothing-to-do-with-school-closures-his-own-statements-suggest-otherwise/ And he admitted that the six foot rule "sort of just appeared". (Unfortunately, based on the commerce clause of the constitution, the CDC has authority to regulate interstate and international travel. However, they still can enforce arbitrary rules based on flimsy science while maintaining impunity.)
Even so, Fauci knows full and well that nearly every state health agency feels obligated to follow his pronouncements. Cautious state health agency bureaucrats readily fall in line to avoid the perceived threat of being sued (e.g. by the teacher's union) or the butt of bad publicity, etc. De Santis was an outlier who understood that Fauci's pronouncements could be defied, because the states are the ones who create actual PH policy. He and the Florida Surgeon General Joseph Ladapo maintained common sense policies during covid to the benefit of Florida's schoolchildren and many others.
Fauci's and the CDC's activities during covid are a convincing argument of the evils of authoritarian deep state bureaucrats. Like venomous serpents, they need to be defanged.
All data and information used and/or developed by the NIH should be posted online daily. It's the public's money so it's the public's information.