|Investing in NIH is Ensuring a Healthier Future. Thank
you for your comments to me and to the NIH staff after the first desk-to-desk this
spring. As I have gone out to many of our constituency organizations, our advisory
councils, and in talking to the public and the press over the past two months,
I have felt that it is very important to share progress with you on a regular basis.
Here are a just a few data-driven examples of return on investment in medical research:
- What has an investment of only $2.60 per year for each American yielded? This
investment through the National Institute of Neurological Disorders and Stroke
has seen the death rates from stroke decline by over 70% in the last
- For an investment of approximately $3.70 per year in the National
Heart, Lung, and Blood Institute research, we have experienced
a 63% decrease in mortality for coronary disease and, over thirty
years, a $2.6 trillion return.
- And for cancer research, the average investment in federal
research per American has been approximately $8.60 per year over
the past 30 years. The results?
- For the first time in recorded history, annual cancer deaths in the
United States have fallen. And there are 10 million survivors, due,
in part, to improved effectiveness of early detection and screening. Thanks
to the doubling, new targeted, minimally invasive treatments for cancer multiplied,
and new drugs were developed for cancer prevention.
- For the public investment in the research supported by the National Institute
of Child Health and Human Development of $2.20 each year, the U.S. rate of
mother-to-child transmission of HIV reduced from 27% to just above 1%, and
there has been elimination of or reduction of several causes of mental retardation; SIDS
deaths reduced by more than 50% in 10 years are among examples of
progress from the NIH investment.
- Due to HIV/AIDS research, 30,000 U.S. deaths have been prevented each
year since 1996 through an annual investment per American of $5
As I have gone out to talk with various groups, I have noticed that there are
some myths which persist in the community. So, I want to describe to you the
realities of the funding situation and discuss with you our strategies to respond
to challenging times.
Although, we flourished during the historic doubling between 1998
and 2003, now NIH has entered into what some are calling a “perfect
storm.” Nationally, we have deep federal and trade deficits,
rising expenditures for homeland security, unexpected economic
and physical devastation from natural disasters like Hurricane
Katrina, and, in order to protect the nation, preparations for
pandemic flu. All of this has occurred in a time where the scientific
community had ramped up its efforts to answer emerging needs, poised
with talented teams and committing resources to continuing discovery.
Understandably, many are deeply concerned about the implications
of these trends.
The NIH budget growth has now decelerated to below inflation and in 2006 the
NIH budget decreased slightly compared to 2005. Understandably, many are deeply
concerned about the implications of these trends at a time when opportunities
have never been better for progress on a broad front, and when so many scientific
programs have positioned themselves to make extraordinary contributions, bringing
together talented teams and committing resources to continuing discovery.
Across the board scientists are worried about their chances of being funded.
We share these concerns. In these times of stress, it is critical to avoid myths
and focus on realities so as to develop well informed adaptive strategies.
Myths vs. Realities
Some scientists believe that falling success rates for investigator
initiated research project grants (RPGs) are due to a shift of
resources away from basic
science and towards large initiatives such as clinical trials or
the NIH roadmap or a larger proportion of agency-driven requests
for applications (RFAs).
Fact: The percentage of applied science was the same — in
1998 and in 2005 and basic science grew from 53.9 to 55.8%.
Fact: A temporary dip in relative basic science funding occurred
in 2003 due to the large biodefense commitment for BSL 3 and 4
laboratory construction occurring
that year and in 2004. In 2007, basic science grow to a level of
56.1% and applied science (which includes clinical trials) to a
level of 40.8%.
Fact: In terms of dollars, there has not been a shift away from R01s and RPGs.
Fact: The proportion of R01s and RPGs issued through RFAs has not dramatically
changed from 1995 to 2005. Both R01s and RPGs more than doubled in funding during
this time period, and the RFA for these mechanisms grew at the same rate.
Fact: Investigator-initiated proposals remain the mainstay of
RPGs. They represent 93% of all R1s and 84.4% of all RPGs as compared
to 91% for R01s in 1995.
Fact: Because of the doubling of the budgets, more RFAs and PAs
were launched, but as a proportion of the budget they have not
increased but decreased since 1999.
Another Myth: Impact of Roadmap
The NIH Roadmap for Medical Research has also been implicated
by some as draining resources from investigator-initiated
The Roadmap is not a single large project but is both a framework
and a dynamic process that was designed through extensive consultations
with the scientific
community. It enables the NIH to be more proactive and synergistic
in addressing areas of emerging scientific needs that no single
can provide but that benefit all of
Fact. The Roadmap consists of a multiplicity of peer-reviewed
projects led by over 308 individual investigators with 345
grants at 133 institutions
in 33 states in 2005. The science within the Roadmap
is very competitive with success rates below those of NIH
as a whole.
Fact. The Roadmap portfolio is balanced with 40% of its funding going to basic
research, 40% to clinical and translational research and 20% for interdisciplinary
and high risk research that would be difficult to support otherwise.
Fact. The Roadmap currently represents about 1.2% of the NIH
budget and will grow progressively to no more than 1.7% of the
budget by 2009 and for the forseeable future.
Fact: In an era of rapid convergence in science, the Roadmap process has allowed
NIH to support innovative, high risk research; incubate new ideas; stimulate
transformative strategies in interdisciplinary research with the basic science
of complex biological systems, and translational science.
Fact: The Roadmap responds to the need for NIH to develop better mechanisms
of coordination and collaboration across institutes and their specific missions
through a bottom up, regular, consultative process of evaluation of shared needs
supported through shared resources that engages the entire research community.
It has been very well received and supported by Congress as a clear demonstration
of stewardship by all institutes and centers.
What Did the Doubling Get Us Anyway?
We made significant progress in aging, asthma, cancer, congenital
heart defects, diabetes, genes/environment and disease, health information,
reduction of infant deaths, modeling influenza, expanded capacity
to address international health, treatment for mental disorders,
new genetic techniques to address neurological disease, development
of non-invasive diagnostics, new steps in protein structure for
drug development, and improved prevention and treatment of stroke,
just to name a few.
The progress is too vast to include in this kind of forum, but
you can read about these developments and others at a new site I
have asked to be created — “Research Results for the Public”
This site will continue to grow as each institute and center adds
examples from its portfolio in order to help the public and our
advocacy and constituency organizations have access to the facts
about progress and the facts about funding. Our new site also gives
access to additional resources. We hope you will bookmark it for
new stories of discovery and updated information about NIH-supported
Again, I invite you to share any comments you have with me, directly, at firstname.lastname@example.org.
Thank you for your interest in NIH and our more than 200,000 NIH-supported
individuals working to improve the health of our nation at more
than 3,000 institutions across all 50 states.
Our next issue will be dedicated to peer review.
Elias A. Zerhouni, M.D.
Director, National Institutes of Health
For information about NIH programs, useful health information,
and additional resources, see the NIH web site at www.nih.gov.
An archive of the Director's Newsletter is available at http://www.nih.gov/about/director/newsletter/archive.htm.