Supporting the NIH before it is too late
Authors: Jake T. Liang
Journal: Hepatology (2006)

It is indeed a sad day for the biomedical research community, when we fall prey to the fears and recriminations that are deeply dividing our nation. Nowadays it has become increasingly painful to open the newspapers and realize that this great nation is facing a crisis in which its leaders hold diametrically opposed agendas, deeply divided by an ideological and partisan schism. These often uncompromising stances do little to assuage the apprehension of an already polarized citizenry. Similar hardship has fallen upon our nation's biomedical research enterprise; an enterprise that traditionally has thrived when its scientific agenda has garnered multilateral support and when its constituents have had the freedom, unity and resources to pursue the mechanisms, treatment, and prevention of disease. The United States leads the world not only in providing cutting-edge healthcare but also in technological and medical advances. These crowning achievements would not have been possible without the visionary efforts of both the political and scientific leaders of this nation. The creation of the National Institutes of Health over 50 years ago was a monumental event. Since its inception, NIH has been entrusted with the mission to chart the course of our nation's biomedical research. It has had an illustrious history, developing innovative programs to power the engine of the nation's scientific enterprise. The inimitable success of the NIH has been driven by many dedicated and talented leaders and more importantly, by the unwavering support and active participation of the scientific community and public. This collective effort forged a redoubtable force in shaping the political agenda on Capitol Hill. Consequently, funding for NIH has enjoyed a sizable growth over the years, particularly from 1998 to 2003 when funding doubled. Unfortunately, the recent economic downturn in the United States and other spending priorities, such as the war in Iraq, has had a profound impact on so-called “discretionary spending” that includes the NIH budget. For the third year in a row, the NIH is facing a flat budget, even less if adjusted for inflation. This cut in funding has had a detrimental effect on both intramural and extramural research. Perhaps not surprisingly in this difficult time, NIH, particularly its leadership, has recently come under attack.1 While none of us would question the importance of an open and reasonable debate on the research agenda and programmatic priorities of NIH, many of us would take umbrage at the strident tone and false statements that have been propagated by such an attack. When the message is pejorative and derogatory, reminiscent of the current political wrangling, we are risking the diminution of our professional stature and credibility. We will not be able to negotiate from a position of strength and unity when others see us as a house bitterly divided. It has been suggested that the NIH is wasting its resources on clinical research that is better suited for the pharmaceutical industry. It is particularly worrisome to categorically dismiss the important NIH-sponsored clinical research, such as the Framingham Heart Study and the Diabetes Prevention Trial, not to mention the Women's Health Initiative, all of which have had far-reaching positive impacts on the health of our nation. This is an affront to both establishments whose dynamic relationship remains necessary for the continued improvement of our nation's health. It is equally remiss to completely ignore the painstaking due diligence of program development at the NIH, and much worse to label it as mismanagement. The NIH leadership has always taken great measure to involve the scientific community in the planning, formulation and implementation of any major programmatic initiatives. Equally, the scientific community has taken great pride in this endeavor as contributing partners. The much-maligned Roadmap, whether one agrees with it or not, was launched after months of planning and discussions held between the scientific community and the NIH leadership. More familiar to the hepatology community is the Trans-NIH Action Plan for Liver Disease Research, which was developed from the collective efforts of many basic and clinical investigators in liver research, together with the staff of NIH and other federal agencies, industry, healthcare providers and interested lay people.2 This plan provides a blue print for NIH funding of liver research over the next 10 years. An open debate on precious NIH resources is undoubtedly the best means to achieve a scientific agenda that considers all possibilities. But it is critically important for us to maintain decorum and focus on the issues in such a debate. We should not be parochial and self-interested in defending our own turf. We cannot afford to set the tone in which the basic researchers rile against the clinical investigators, the public sector against the private industry, and the scientists against the policymakers. The scientific community must be politically proactive and rally around a common cause: the continuous investment and growth in biomedical research by our nation.3 In these lean times, consideration should be given to innovative means of developing alternative resources to support biomedical research.4 Finally, ad hominem criticisms of the leaders of the NIH and other granting agencies could undermine efforts to achieve the needed goals. A Capitol Hill lobbyist who advocates for NIH has lamented that such a criticism is “handing a bat” to those naysayers who view NIH as another federal bureaucracy to dismantle.5 This comment illustrates the potential danger of these misdirected criticisms. As James Thurber has reminded us, “let's not look back in anger or forward in fear, but around in awareness and resolve.”