Republican House Speaker pushes ahead with NIH reform plan, here’s what’s wrong with it

House Energy and Commerce Committee Chairwoman Cathy McMorris Rodgers (R-WA) has introduced a proposal to reform the National Institutes of Health (NIH). It is no exaggeration to say that NIH is the most important health science agency in the United States. Because NIH is the largest funder of biomedical research, what it does and how it operates ultimately affects scientists and science across the country, which in turn affects the health of virtually every American. So the big question is: is this proposal actually based on health science or politics?

That’s because in recent years, many politicians have tried to thoroughly politicize science. So while many scientists and health experts might agree that the NIH needs major reform, we should be skeptical of any reforms proposed by politicians rather than actual science and health experts. After all, would you watch a movie directed and produced by a politician? How would you feel confident in an Olympic team that was entirely coached and trained by politicians, rather than people who actually played the sport?

Were these proposals really formulated by scientists and health experts?

Well, if you look closely at Rogers’ “Reforming the National Institutes of Health, A Framework for Discussion” document, you’ll see very little evidence that the proposed changes to NIH come from actual science and health experts. statusRogers, who is not a scientist, researcher, or health expert, and Rep. Robert Aderholt (R-Ala.), chairman of the House Appropriations Subcommittee on Labor, Health, Human Services, and Education, also not a scientist, researcher, or health expert, supported the proposal, writing: “Our message to scientists, researchers, patient advocates, colleagues, and the American people is simple: “Our doors are open. Work with us. Become our partners.”

Well, imagine someone building a house for you to live in, and then later saying, “We didn’t ask for your input when we designed and built that house, but now we’d love to work with you.” Well, that’s not the same as letting them design and build it from scratch. And what guarantee do you have that they’ll listen to your suggestions? Rogers and Aderholt didn’t say which scientists and health experts they’d allow as partners, or how.

What is the scientific basis for NIH’s proposed new organizational structure?

Rogers’ document also proposes a major reorganization of the NIH, reducing the NIH’s current 27 Institutes and Centers (ICs) to 15, but provides little scientific justification for the proposed new organizational structure. For example, in this new organizational structure, why is the brain and nervous system kept separately in the National Neuroscience and Brain Institute, while all other organs such as the heart, lungs, and digestive tract appear to be grouped together in the National Body Systems Institute? Anyone who has ever tried to hold in a fart knows that the brain is normally connected to the rest of the body.

Moreover, the intended purpose of many of these new ICs is not very clear from their vague names. For example, the proposal for the National Institute of Health Sciences seems a bit odd because it is not the kind of “health science research” that the entire NIH should be doing. It is not like other institutes will be doing “stuffed animal science research.” The same can be said for the National Institute of Innovation and Advanced Research. Does this mean that other institutes and centers will support research that is not innovative or advanced research?

All of this does not mean that NIH is not in need of major restructuring. Many of the foundations of NIH’s current structure were formed decades ago. In some cases, they were formed before polyester leisure suits became fashionable in the 1970s. Just as adding fashion accessories does not cover up the fact that you are wearing a leisure suit on a date, simply adding to or tinkering with the current NIH structure may not solve the deeper problems of the existing structure. For example, keeping ICs separated by body parts or specific diseases may continue to favor a siloed approach that “only looks at the back of the eyeball” when a more integrated systems approach is needed. Thus, an overhaul of the NIH structure may be justified, but it must proceed in a way that is justified by science, not political whims.

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

Ultimately, if we want to do good science, we need to make it easy for scientists to do it. But that hasn’t happened since the 1990s, and the amount of funding allocated to the NIH each year has barely kept up with inflation, even as the population continues to grow and the costs of scientific research increase at a faster rate than inflation. NIH funding is the lifeline for most independent biomedical researchers. Independent means not working for a company that sells a specific product. But Rogers’ proposal fails to acknowledge the fact that NIH grants have become much harder to obtain over the past few decades, due in part to the relative scarcity of NIH funding.

Her proposal also fails to address the growing administrative burdens facing scientists. Few scientists would have said as kids, “I want to do science so I can fill out forms and attend conferences.” Yet Rogers’ proposal introduces even more reporting requirements for NIH grant recipients without attempting to alleviate the existing administrative burdens facing scientists.

Moreover, job security is declining for scientists who are constantly on the grant treadmill, searching for funds to support their research activities and maintain their positions. Many academic research institutions turn to a “soft money” model, where the moment they fail to secure sufficient external grant funding, their effective salary disappears. And having a salary is important for things like eating. Imagine in which direction scientists and aspiring scientists will move when it becomes easier to make money by becoming a YouTuber or a TikToker and selling stuff.

Rogers’ proposal, which would limit researchers to only three NIH grants or awards at a time, would make things even tougher for previously highly productive scientists. Well, things don’t work out so well if we effectively tell successful people, “Well, we don’t want you to be too successful.” If we want to provide more support to new scientists, we can’t just slice the same pie in different ways; we need to make the whole pie bigger.

Moreover, while Rogers’ proposal mentions stimulating more innovation, it doesn’t specify how that will be achieved. This is like saying “you should try to look attractive on dates.” True innovation comes with the freedom and resources when scientists feel free to take risks and don’t have to constantly worry about things like funding and job security. You don’t say to someone clinging to the edge, “Take the time to innovate. Try something new.”

Finally, there is the anti-science problem that scientists are currently facing. With so much misinformation and disinformation about science, and with the politicization of what should be scientific issues like climate change and COVID-19, the last thing we want is for politicians to decide how science is funded and conducted. Why not let the scientists themselves do it? Congress could commission an independent committee of scientists, health experts, and patient advocacy groups to design and propose a new structure for NIH. These could be done in a transparent way that incorporates broader public input and shows how that input is being taken into account.

Looking back at the history of the United States, the founders of this country included scientists like Thomas Jefferson and Benjamin Franklin. It owes its growth to global prominence in large part to scientists (many of whom immigrated from other countries) and scientific innovation. In the same way, America’s future growth or decline depends on what science looks like and whether it is led and carried out by real scientists and not politicians. After all, science is not something you can fake until you make it. And good science tends to build a nation, while a lack of it can tear it apart.