Peter H. Schuck, the former deputy dean of the Yale Law School, recently published the book, Why Government Fails So Often: and How It Can Do Better,1 a rather depressing explanation of how public regard for government has steadily declined since the 60s and 70s.
After 10 chapters that detail why the US Federal Government fails and fails again, along comes Chapter 11. No, not a chapter on bankruptcy, but on “Policy Successes.” And one of the several policy successes he mentions include an agency that you and I are well familiar with … the National Institutes of Health. The author notes, “Even small-government advocates generally concede an important role to the Federal Government [in] basic research – the creation of knowledge – in areas where private actors lack incentives to invest.” NIH-funded research has yielded important discoveries that have led to new treatments; has enabled excellent institutions of learning to flourish; has created cutting-edge job opportunities; and has forged strong collaborations with the private sector.
Yet, not all is well with the NIH extramural science enterprise. The growth of the NIH budget has stalled over the past decade2 and not kept pace with inflation, or our biomedical research purchasing power3. We live in a hypercompetitive environment, with a number of associated problems: a peer review system that must distinguish among many excellent proposals in light of restraints on resources and capacity4, 5, 6; unstable funding; administrative burdens; and trainees and young investigators who fear for their future. A number of recommendations7,8, 9, some of which may have been considered radical even a few years ago, have been put forth – cap salaries, cap support for individual labs, support people as opposed to projects, be more judicious about support for big science projects, support more staff scientists, train young scientists for non-academic careers, and re-align incentives to enable more efficient spending (e.g., on core facilities10,11,12) and to encourage workplaces in which diversity and collaboration are less the exception, more the norm.7, 13
While I was the lead of the NIH cardiovascular program division (within the NIH’s National Heart Lung and Blood Institute), I had the chance to work closely with NIH Director Francis Collins on unique programs and initiatives that explore innovative ways to support research, such as fostering NIH-funded comparative effectiveness research14, on making PCORnet a reality15 and on building the Precision Medicine Initiative.16 I also have had the opportunity to work with colleagues throughout NIH on a number of analyses and publications resulting from data-driven approaches to look at issues facing the research community. And more and more I have been drawn to the national — indeed international — conversation.
It’s a conversation that concerns itself with nothing less than how to save the American biomedical research enterprise. To be successful, NIH must nurture, foster, and develop a learning culture of “results-based accountability.”17 Accountability means deep and sometimes painful conversations about valid metrics, about stories that underlie metrics, about the economics of science, about evidence-based considerations of what kinds of partnerships and strategies are most likely to “turn the curve” – really about applying the scientific method to ourselves at NIH. And it means that we have to be willing to talk, even in public, about our shortcomings and our ignorance. In a strange way, my greatest pleasure about working at NIH is that I can work at an agency that “admits” that its cardiovascular trials don’t publish18; that its program staff may be failing by relying too much on peer review percentile scores for making funding decisions5, 19; that other models (e.g., PCORI) for funding research have something worthwhile to teach us20, and that it may be putting too much money into “big science.”21 But I’m also excited and optimistic about NIH, because its extramural leadership has been so willing to embrace rigorous methodologies to think about its own work – its successes and its failures. And NIH leadership is willing, indeed eager, to seriously consider wholly new ways of doing business.
I look forward to working with you, the extramural community, in my new role as the NIH deputy director for extramural research. I believe that by building upon the outstanding work of Dr. Rockey and her team, and by building upon the data-driven work my colleagues and I have had the fortune to conduct over the past few years, we can take the nation’s biomedical research enterprise to the highest level it’s ever seen.
I am also very much looking forward to carrying on and building upon Dr. Rockey’s tradition of blogging. I plan to use the blog to help connect you with the NIH perspective, and, even more importantly, to help connect us with yours. So … welcome to the Open Mike Blog at the NIH. I look forward to hearing from you.