NIH in the Budget Doldrums

What ended the spectacular budget growth of the National Institutes of Health, and what can bring it back?

For decades NIH was the bi-partisan darling of Capitol Hill, receiving substantial budget increases even in bad economic times. Among government agencies, NIH was uniquely free of critics, except for those who urged it on to even greater wars on disease. Advocacy groups championing research on their ailments successfully agitated for expanded spending, often relying on afflicted celebrities in the witness chair to dramatize their case. Legislators offended no one by voting for health research. Under a Congressional commitment to double NIH spending over five years, its budget soared from $13.6 billion in 1998 to $27.1 billion in 2003 — absorbing about half of all federal civilian research spending. And then, despite small increases, which brought the budget this year up to $28.4 billion, the real growth abruptly stopped, leaving NIH today with eroded purchasing power and many unfulfilled expectations.

NIH’s budget woes have hit academe. Though Washington provides little money for university lab buildings, the 1998-2003 budget doubling inspired campuses throughout the country to finance record amounts of construction in anticipation of a continuing gusher of NIH research money. Staff appointments were made or planned. In the gold-rush spirit, the doubling of money produced a doubling of grant applications, leading to a drop in success rates, which led to a reduction in grant dollars and shortened durations to accommodate more grantees. No wonder gloom is prevalent in the life sciences, for which NIH is the financial mainstay. Even the venerated cancer budget has leveled off. NIH funds for basic behavioral and social science reached $1.052 billion in 2004; for 2007, the White House has proposed a ground-losing $1.050 billion. Searches for other sources of money have yielded little, because there’s nothing on the scale of the NIH bankroll.

Success, envy, and a tarnished halo can be credited with cooling the political ardor for NIH. The end of the Cold War produced shifts in political attitudes toward the various fields of science. As the Soviet menace vanished, the Pentagon sharply reduced its support for the so-called hard sciences, while U.S. spending on space and energy research stagnated. Physicists, once the royalty of government-financed science, lost their dream machine in 1993 when Congress aborted the Superconducting Super Collider. Meanwhile, NIH prospered, abetted by a healing, benign image and the promise, often shamelessly exaggerated, of advances in gene therapies and other medical miracles. With Congress, as always, elbowing away the White House in health research, the budget doubling came easily — but sowed resentment in the less-favored fields of science, particularly energy, space, and basic physics. “When’s our turn?” they demanded after successive years of stand-still budgets. As these neglected researchers worked the Washington corridors and badgered their Congressional friends, the glut of money that had rapidly descended upon NIH reduced the sense of urgency about the need for even greater support.  The political state of mind concerning money for NIH was picturesquely stated by White House Science Adviser John H. Marburger III when he told Science & Government Report last July, “I think there’s a sense that we need a little while for the snake to digest the pig.”

In February, the White House announced the American Competitiveness Initiative, which declared “President Bush’s strong commitment to double investment over 10 years in key Federal agencies that support basic research programs in the physical sciences and engineering.” NIH and health research were not included — or even mentioned. The clear message was that health research had had its turn at the budget trough.

But where was Congress, long the champion of strong budget growth for NIH, regardless of White House preferences? To some extent, Congressional affection for NIH was blunted by a rare whiff of scandal at the great  institution. Starting in 2003, the final year of the budget doubling, press reports revealed that some 40 senior staff members at NIH had covertly reaped thousands of dollars in pharmaceutical consulting fees without fulfilling disclosure requirements. The miscreants were a mere sliver of NIH’s 6,000 scientists, and the amounts involved were piddling on the scale of big-league Washington corruption. But the disclosures, painfully explored at several Congressional hearings, were nonetheless shocking because of NIH’s saintly image.

While that sorry situation has detracted attention from NIH’s case for renewed growth, Congressional guardianship of health research has been lost in partisan bickering over weightier matters, such as war, terrorism, tax policy, and health care. Furthermore, through the vagaries of seniority and committee chairmanships, NIH in recent years has lacked the passionate, well-placed crusading advocates who fired up their colleagues to force feed money on health research. The current chair of the key House appropriations subcommittee for NIH is Rep. Ralph Regula, a rural Ohioan, age 81. First elected in 1972, Regula has quietly presided over NIH money matters, rather than beating the drums for more, as was the style of a long string of predecessors in that post. In the Senate, Regula’s appropriations counterpart, Arlen Specter, is a veteran NIH supporter, but as chair too of the politically hot Judiciary Committee, he has devoted little time to NIH affairs.

The lame-duck Congress still must complete work on agency budgets, including NIH’s, for the fiscal year that began October 1. In the meantime, NIH runs at the level of last year’s budget, which means a further loss of buying power.

A sudden reversal of Spartan spending for health research does not appear to be in the works. But despite gloom-mongering about public hostility to science, the budget slowdown is not likely to be of long duration. It is the product of success and the unfortunate convergence of a variety of political and personal factors. A turnabout eventually will come, however, because the American public is hooked on medical hope, as reflected in popular support for stem-cell research. And the din of disappointment about the money needs of science is mounting toward unavoidable political notice. In 1995, when the newly elected Republican Congress pledged deep cuts in government spending, the then-NIH Director, Harold Varmus, delivered a gloom-filled lecture titled “Biomedical Research Enters the Steady State.” Two years later, the doubling commenced.

Give it a couple of years, a new committee chair or two in the right places, and another doubling commitment for the NIH budget will rise on the Congressional agenda.  Until then, a sense of proportion requires us to recognize that at $28 billion per year, health research is a safe distance from penury.