Healy Proclaims Her Long-Range Objective: Rapid Escalation In Number Of NIH Grants

Clearly established research goals, awards of shorter duration, and vigilance over costs will do the trick, says the agency,s director BETHESDA, Md.--National Institutes of Health director Bernadine Healy hopes to increase by almost 50 percent the total number of grants the agency awards over the next several years. To do it, she says, NIH must trim budget requests by principal investigators and tighten up on indirect costs paid to institutions, manipulate the length of its grants awarded to avoid budgetary crunches, and be more generous with funding of applications ranked most highly by peer-review panels. If successful, the plan over time could have a major impact on the way that scientists obtain their funding from the agency. This year NIH will fund more than 21,000 research project grants, a number that has grown very slowly over the past several years. Healy, who became director in April, wants that number to top 30,000 annually by the end of the decade as part of a major campaign to increase federal support for her agency. At the same time, she and other NIH officials would like to see the success rate of applicants rise to at least one in three, from the current level of one in four. While those goals won't be achievable without additional money, Healy says, it will ensure that NIH sets ambitious objectives for itself and then works hard to meet them. "What's happened to [the size of] our portfolio [of grants] over the years is a pretty sad story," Healy told the Advisory Committee to the NIH Director, a panel that met here last month. "NIH has never done long-term planning very well, but maybe we need to learn from our sister agencies. NASA may never get to Mars, but at least they know where they're headed." To achieve a sizable boost in grants, Healy said, she is leaning toward funding decisions that favor institutions with low indirect costs rates. The increase would also involve granting awards that may extend for only two or three years, compared with an average last year of 4.3 years, and a sliding scale of awards in which ideas rated most highly by peer-review panels receive full funding while proposals that are lower-ranked have their budgets cut significantly. Although few members of the advisory committee who attended last month's meeting took issue with Healy's words, many expressed concern that such adjustments might hamper the efforts of individual scientists and threaten their institutions. David Challoner, vice president for health affairs at the University of Florida in Gainsville, questioned whether institutions with high indirect costs rates may be pricing their faculty out of a chance at an NIH grant, or even if NIH might start to become more interested in an application's overall budget than its scientific merit. "How far are you going to slide in order to play the numbers game?" he asked. "This may not be a popular thing to say," Healy replied, "but schools need to know that they will be hurting their scientists if they don't control their indirect cost rates. "There's no hiding the fact that a scientist [whose proposal is] on the margin from an institution with a lower rate will fare better than one from a school with a higher rate." The Consequences Harvard University geneticist Philip Leder has been an outspoken critic at previous committee meetings of the idea that the number of grants is the best way to measure the health of biomedical research. During a break in the meeting, he discussed some of the consequences for the scientific enterprise of a drive to boost sharply the number of total awards. "Look at the Shannon awards," said Leder, referring to new awards intended to provide short-term funding for scientists who fail to obtain a regular NIH grant (The Scientist, May 13, 1991, page 3). "With their 20 percent cap on indirect costs, I don't know how many universities are going to be able to afford them. "Nobody is arguing that it's right to fund only the top 15 percent of the community, and leave the others in the lurch. But there are real costs associated with good research, and you can't simply ignore them in order to spread the money around." Shifting The Burden Matthew Scharff, director of the cancer center at Albert Einstein College of Medicine at Yeshiva University in New York, pointed out at the meeting that reducing support staff, a common way of trimming the cost of a grant, simply shifts the burden to others. "I no longer have a technician [on my grant], and that means a postdoc or a graduate student has to do the work," he said. "It's not a very good use of their time." Still, Scharff contended, such cost-saving measures are inevitable. "If it comes down to applying for a grant again in three years rather than four," he said, "we can adjust. After all, scientists are pretty flexible." The springboard for many of Healy's ideas was an exercise in cost control that Congress pressured NIH to undertake last fall (The Scientist, Sept. 3, 1990, page 1). Bombarded by complaints from scientists that grants were harder to come by despite a growing NIH budget, Congress urged the agency to look at its policies regarding grant size and duration and its criteria for selecting the most meritorious proposals. Accompanying that request was an implied threat from Congress: Get your financial house in order, or we'll do it for you. Under the leadership of acting director William Raub, NIH held hearings and drafted a plan aimed at meeting the concerns of Congress (The Scientist, Jan. 21, 1991, page 1). The final document, approved by the Bush administration and released last month as "A Plan for Managing the Costs of Biomedical Research," commits NIH to holding increases in grant costs to the rate of a biomedically oriented price index and to shortening the average length of grants slightly. Too Timid? While several NIH officials say they believe the plan addresses most of the issues raised by Congress, some speculate that it's a bit too timid for Healy's liking. "The director told us that it was fine as far as it went, but it didn't go nearly far enough," says John Diggs, NIH deputy director for extramural research. "So we've already started to work on Phase II." That next stage of the cost management plan has become folded into a broader internal review, now under way, of all NIH policies. The result will be a document that Healy hopes to have finished in time for hearings next spring before Congress on the agency's proposed budget for fiscal year 1993, which starts Oct. 1, 1992. NIH's senior management will gather next month at a retreat to begin to fashion such a document, which, Healy said at the meeting, will then be circulated widely among the NIH community and revised as needed. Healy said she intends to use the plan to sell the White House, Congress, and the public on the need for a more rapid growth in NIH's budget during the 1990s. "The administration has pledged a doubling of the budget for the National Science Foundation," she reminded the advisory committee during her talk, which she entitled "A New Dimension of Biomedical Research." Sense Of Urgency But during the address, which opened the day-long meeting, she showed the committee a slide of the president's 1992 budget request that placed NIH at the bottom of the heap in terms of the percentage increase requested by each of the government's agencies that fund science. "For whatever reason," she said, "we as a community are failing to get across the sense of urgency of what is needed in biomedical research." Healy said that NIH can no longer rely on the outcome of the budgetary pattern that developed during the Reagan administration, whereby Congress routinely added hundreds of millions of dollars to the tiny increase that generally was requested by the president. "Because of last year's budget agreement [which limits overall federal spending and prohibits shifts among domestic spending, military spending, and foreign aid], the president's budget is becoming more and more what our budget ends up looking like," she said. She noted that last year, even though Congress wound up doubling Bush's initial request for a 4.6 percent increase, the total appropriation didn't allow NIH to make much progress on two key indicators--the success rate of applicants and the number of new grants awarded. This year, in a budget still wending its way through Congress, Bush has proposed a 6 percent increase for NIH in fiscal 1992. The House of Representatives barely exceeded that figure in its appropriations bill, and did so only because of savings it assumed from a lower rate of reimbursement to institutions for administrative overhead costs. "NIH is still a favored child of Congress," Diggs told the advisory committee after Healy spoke, quoting a House appropriations committee staffer, "but it's no longer the favorite child. Now we have to compete with such other favorite research children as space and the environment." Obsessive Concern To succeed, Healy said, the biomedical community must be weaned from its obsessive concern about the number of new and competing grants that NIH funds each year. This category represents less than one-third of the total number of grants supported each year, with the rest being continuing awards. In its place, she said, should be a focus on improving the nation's health through research, training, and improved facilities. The preoccupation with the number of new and competing grants that Healy referred to began in the mid-1980s in response to proposed sharp cuts in the NIH budget by the Reagan administration. Raising the number to more than 6,000 became a sacred cause for supporters, who claimed victory when the total reached 6,440 in 1987. But Healy and other officials now acknowledge that such success came at a high cost, forcing NIH to maintain a higher level of new grants than it could afford, in addition to triggering significant cuts in the size of each grant to accommodate some arbitrary figure of new awards. And last year, when the number of new and competing research grants dipped to 4,845, many scientists were outraged. Healy said she believes that the single figure of new and competing grants is a false barometer of the health of the research enterprise. "I think we should get those numbers out of our brain, and think more broadly about the entire portfolio," she said. "The keystone is investigator-initiated research, and everything we do derives from that fact." To emphasize her point, she suggested that scientists stop looking at research project grants--a category that includes most types of investigator-based research--as discrete amounts of funding and begin to see them as "a unit response to opportunity. In that light," she said, "21,000 such responses are inadequate to the problems facing this country." A 50 percent boost in "responses" would be a more adequate level, Healy suggested. Indeed, a chart that was presented at the meeting shows a constant increase in NIH's budget (see page 4). The figures, incorporating the agency's best estimate of what it needs, reach a level of 38,000 grants by 1999. A second projection, which includes a mixture of shorter, smaller grants, also tops 30,000 in 1995 and then flattens out, reaching a level of 32,000 or 33,000 grants in 1999. In reference to the projections, Healy noted: "In no way am I lobbying for these numbers. In fact, we'd look pretty foolish if we requested an uncontrolled rise [in the NIH budget]. But I think that 30,000 grants by 1999 is a reasonable target. The question is, `How do we get there?'" Healy said that NIH has stymied its growth by failing to spell out goals relating to public health that could capture the imagination of Congress and society. And she urged the research community to put the public good ahead of its own concerns about scarce resources and its problems in winning federal funding.

Healy Proclaims Her Long-Range Objective: Rapid Escalation In Number Of NIH Grants

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