Congress Assails NIH Spending Practices; Report Presses For Reforms, Restraints

A House panel, demanding changes in the way grants are managed, accuses scientists of overstating the crisis in research funding WASHINGTON--In a report that has left National Institutes of Health officials "a little shell-shocked," a House committee has laid out an unprecedentedly specific set of spending guidelines in an effort to fix what it sees as a longstanding problem in the way NIH has handled its rapidly growing budget. In blunt language, the House report says its members are tired of hearing scientists whine about a lack of money, and they're unwilling to wait any longer for NIH to do something about the way it allocates grant funds and its perceived inattention to costs when evaluating proposals. Scientists like Oliver Smithies, a professor of pathology at the University of North Carolina at Chapel Hill are apprehensive about the House initiative. Smithies is the kind of biomedical researcher who exemplifies the dilemma that has emerged as a key issue as Congress works on this year's NIH budget. With an individual investigator grant from NIH that's been renewed five times over the past 20 years and a new, 10-year award from NIH that is meant to reward sustained excellence, he receives a hefty and ever-increasing chunk of long-term federal support. But the 64-year-old professor is also the type of scientist whom NIH most wants to fund. That's because his peers--through their assessment of his grant proposals--think that he's one of the best genetics researchers in the world. His is the sort of case that forces lawmakers to ask how they are supposed to reconcile growing pressure to reduce the federal deficit with the fact that the best scientists--and the best science--cost the most. That question is linked to another, equally pressing, one: Why are biomedical scientists complaining so loudly about a crisis in funding, when support for biomedical research is at an all-time high? "The Committee has heard from scientists throughout the United States that the system of federal support for the health sciences is in crisis. This crisis has been overstated," declares the report from the subcommittee of the House Appropriations Committee that has jurisdiction over NIH and most other federal biomedical research agencies. The answer, according to the report, lies in the way that NIH has managed its budget. The report accompanies the 1991 appropriations bill that the House approved in July. It says that individual grants are too large and extend for too long a time, and that the process by which they are awarded gives insufficient attention to the overall cost of each grant. "The current system does not serve adequately either scientists or taxpayers," the report says, adding, "the Committee, in developing this financial management framework, would have preferred to be responding to a plan formulated by the NIH leadership. In the absence of such a proposal, however, the Committee believes that the following elements should form a basis for bringing more stability and predictability to NIH's current fiscal situation." Specifically, the report calls for: A minimum of 6,000 new and competing grants annually and an overall total of 24,000 grants. That compares with 4,600 new grants this year--the smallest such number in more than a decade--and 20,300 total grants, down slightly from a peak of 20,600 in 1989. A reduction in the average length of a grant, from the current 4.3 years to 4.0 years. That term has grown from 3.3 years in the mid-1980s. Holding the annual rate of growth in the size of a grant (now about $180,000) to the rate of increase of a special price index of biomedical goods and services. >Asking those outside scientists who review NIH grant applications, as members of some 90 study sections, to weigh both the direct and administrative costs of the research at the same time they are judging a proposal's scientific merit. Eliminating the euphemistically labeled "downward negotiations," through which NIH unilaterally cuts the size of an award. Last year those cuts amounted to more than 10 percent of the grant. The committee would prefer to have NIH trim the initial request on scientific grounds, rather than make cuts strictly for financial reasons once the project has been funded. Increasing the percentage of applications that are rejected outright, thereby shrinking the number of proposals that are classified as "approved but not funded." Currently, NIH study sections approve some 97 percent of all applications, although only about one in four are ultimately funded. The report is a combination of carrot and stick. On the one hand, the House boosted NIH's budget for next year by nearly $1 billion to a record $8.6 billion, and provided support for a record number of grants. On the other hand, it said that NIH must adopt "more aggressive cost management and cost control measures." The subcommittee that wrote the report is chaired by Rep. William Natcher (D-Ky.), who each year conducts several days' worth of hearings on the NIH budget. "I've never seen anything like this in report language," says Anne Houser, chief of NIH's legislative liaison branch. "The committee was pretty explicit in what they wanted, and I think that it did so in order to get NIH's attention." A House committee staffer confirms Houser's sense that the panel felt "frustrated" by what has occurred during the past few years, during which time NIH's budget rose steadily but complaints about inadequate funding grew ever more strident. "The committee feels that it [the current problem] is largely a self-inflicted wound," says the staffer, referring to the increasing size and length of grants. "And they are looking for assurances that, whatever NIH decides to do, the members won't be facing the same problems a few years down the road." The staffer says he's heard that NIH "was a little shell-shocked by the language. It was sufficiently different for them that they don't know quite how to respond." At the same time, the staffer says that the committee decided not to be more prescriptive because it hopes NIH will respond quickly to the issues it has raised. "In an earlier version these were directives," the staffer notes. But the language was toned down to ask merely that NIH "consider them" in formulating its own plan. NIH is listening closely, according to John Diggs, NIH's deputy director for extramural affairs. At the same time, says Diggs, NIH believes that the issues are complex and that the House is only one of many players in setting policy on biomedical research. "We take these issues very seriously," says Diggs. "But we don't plan to rush to judgment because things can change." Diggs was referring to the fact that the Senate must still act on NIH's budget, and that the two houses must then resolve their differences before NIH receives its final marching orders for the fiscal year that begins October 1. In the meantime, Diggs says, NIH has divided the House report language into 10 suggestions and has formed a separate committee to examine each one. The idea of having study sections look more closely at overall costs, for example, is being investigated by a group chaired by Jerome Green, director of the division of research grants, which runs NIH's peer review system. Green says that each panel has been asked to submit its report to the acting NIH director, William Raub, by the middle of October. The cost issue also happens to be one of the most contentious matters that NIH must face. As Houser notes, "When you start to talk about cost control, you're talking about how much money the medical community is going to be getting from NIH. You can bet people are worried." Some observers believe that part of the problem of cost control stems from the increasing quality of the applications that NIH is receiving. Indeed, NIH has figures that show that the grants at the top of the heap--those with the lowest scores (on a scale of 100 to 500, with 100 being the most highly rated proposal)--cost more than those farther down the list. Lobbyists worry that Congress will decide, as Dave Moore of the American Association of Medical Colleges says, "to buy cheaper research" as a way of stretching the biomedical dollar. Smithies, for one, says that such an approach would be foolish. "Cheap" science carries a hidden price tag, he says--the loss of some of the expected benefits of the research. "What people have to remember if they say, `Let's cut someone's budget by X amount,' is that he or she won't be able to make the kind of progress that's expected." Congress has also complained in the report that the cost of science is rising faster than the rate of inflation. That criticism, Smithies says, while justified, can be explained in two words: greater productivity. "The rate of obtaining new knowledge has increased much faster than the rate of inflation," he says. "And that knowledge can be put into effect much faster than would have been done 20 years ago. I can promise you that our ultimate success in finding a vaccine for AIDS will occur much faster than it would have a generation ago. "And there's another reason, too," Smithies says. "Things that once had to be made can now be bought. That represents a tremendous increase in productivity. Instead of taking two months to make something myself that I need--a protein or a particular piece of equipment--I can go buy it from industry and have it in two days." Moreover, only a portion of the cost of a grant goes to the investigator. A sizable share--almost an equivalent amount at some medical schools, based on a formula negotiated by the institution and the government--goes for what are known as "indirect costs." These payments are meant to cover the institutional cost of the research--the buildings, utilities, and overhead associated with the grant, as well as the people needed to administer it. The committee's suggestion that indirect costs should play a larger role in NIH's decision on which projects to fund is a potential threat to those universities with the highest indirect cost rates. But it also worries NIH administrators whose job is to support the best possible research. "We would approach any change in the ground rules about how to review grant proposals very, very carefully because it's so important to us," says Diggs. "We are aware of the concern within the public and Congress to keep costs down, and it may be possible to build some consideration of costs into the review process at some point. "But costs are determined by many factors, including the location of the research. And we don't want to put [schools along] the two coasts at a disadvantage simply because it's cheaper to do research in Kansas than it is in Boston or San Francisco." The House subcommittee report invites the new NIH director "to submit revisions to this plan as part of the 1992 budget, or earlier if he deems it necessary." As the House staffer notes, "We'll back away real fast if NIH offers up a reasonable plan. We don't want to micromanage the agency." However, many observers doubt that such a plan will be drafted anytime soon, noting that, after 13 months, the Bush administration is still looking for a permanent successor to former NIH head James Wyngaarden. If the search lasts much longer, says the staffer, "then we'd be happy to entertain a proposal from Dr. Raub."

Congress Assails NIH Spending Practices; Report Presses For Reforms, Restraints

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