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Top Scientists Suggest A Few Fixes For Medical Funding Crisis

Dr. Harold Varmus, a Nobel Prize winner, cancer biologist and director of the National Cancer Institute. (AP)

Many U.S. scientists had hoped to ride out the steady decline in federal funding for biomedical research, but it's continuing on a downward trend with no end in sight. So leaders of the science establishment are now trying to figure out how to fix this broken system.

It's a familiar problem. Biomedical science has a long history of funding ups and downs, and, in the past, the system has always righted itself with the passage of time and plumper budgets.

"You know I lived through those [cycles]; I know what they were like," says cancer biologist Dr. Harold Varmus, whose long research career includes a Nobel Prize. However, he says, the funding challenges "were never, in my experience, anywhere as dramatic as they are now."

Varmus knows the problem well — now head of the National Cancer Institute, he directed the entire National Institutes of Health in 1998, when President Clinton started an ambitious push to double the NIH budget.

"It has to be recognized that we actually weren't asking for that much that fast at that time," Varmus says. "And many voices — including my own — were saying, 'Yes, this is great, and we can spend the money well; but you have to be prepared for what you do at the end of that five years.' "

We have to remember that this is a fragile system. 'Do no harm,' the doctor's mantra, is very applicable here.
Dr. Harold Varmus, director, National Cancer Institute

Doubling the budget, he realized, would, of course, encourage rapid growth — so smaller, continual increases would then be required to keep this bigger enterprise humming.

And the annual budget did grow to an impressive size — surpassing $30 billion. But (adjusting for inflation) today's federal budget for biomedical research has given up much of that gain.

Many scientists say the obvious solution is to give them more money.

"There's no doubt that having a bounce back — an increase in our funding — would be helpful," Varmus says. "But I don't think it's going to solve all the problems at this point."

There are now deep structural problems in the way research is financed. Scientists and universities alike are thinking less and less about the exciting frontiers of science, and more and more about tactics they can use simply to stay afloat.

"It's difficult to operate, and difficult to operate in an adventurous way," Varmus says. And that's bad not just for the scientists, but for patients and universities hoping to benefit from the fruits of a scientist's labor.

One of the biggest changes is in how NIH money is used. These days, it's not simply for conducting experiments — it's increasingly spent on scientists' salaries and even to repay the loans on new laboratory buildings that sprang up like mushrooms during budget boom times.

"This is a very tricky business," Varmus says, "because we recognize that universities are under tremendous pressures. In states, for example, that have some of the best public universities in the country, the amount of money that can be used to support research activities has declined precipitously."

So the NIH can't simply make bold new rules about how these universities can spend grant dollars. Instead, Varmus and some colleagues have been focusing on gentler changes that might help.

"We have to remember that this is a fragile system, Varmus says. " 'Do no harm,' the doctor's mantra, is very applicable here."

One idea is to reduce the number of young scientists being trained for careers that don't exist, and to instead hire staff scientists to carry out more of the day-to-day lab work that the apprentices now perform.

"Staff scientists don't necessarily have to have Ph.D.'s," Varmus says. "They might have master's degrees. And being a staff scientist these days is quite an appealing way to practice science," because you can concentrate on doing the work, and not get tangled up in the sometimes noxious process of fighting for funding.

The NIH could also help some scientists avoid the money scramble by following the example of the Howard Hughes Medical Institute, Varmus suggests. This private philanthropy gives generous grants to individual scientists, based on that person's broad ideas and talents, rather than funding a specific research proposal.

Whether scientists can gently solve the structural problems remains to be seen, Varmus says. Last April, he and some colleagues laid out several broad ideas in "Rescuing U.S. biomedical research from its systemic flaws," an avidly read article in the Proceedings of the National Academy of Sciences.

He and his co-authors are hoping to broaden the conversation. "We want to bring together folks who are in government, administration, scientific societies, advocacy groups, students, faculty, even members of Congress," Varmus says.

One idea, he says, among other possibilities, might be to convene a summit akin to the Asilomar conference in 1975, where scientists gathered to set their own rules for dealing with genetic engineering.

Whatever the ultimate solution, much is at stake.

"We have a system that has worked well in the past, that has made the U.S. the leader in biomedical research worldwide," he says, "and while I don't think we've lost that [edge] yet, we do see a rising tide in lots of places."

Maybe, eventually, the threat of losing this competitive edge will spur the U.S. Congress to address the underlying problems in the way it authorizes funding for biomedical research. But that appears to be a distant prospect. In the meantime, another ancient injunction to doctors, "Physician, heal thyself," seems apt. The research establishment will try to find a way to ease the pain, on its own.

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Transcript

DAVID GREENE, HOST:

And we've been hearing this week about some of the huge challenges facing people involved in biomedical research in this country. Funding from the National Institutes of Health doubled a decade ago and has been falling ever since. This is hampered the most creative research, threatened the careers of scientists and caused economic pain at universities. NPR's Richard Harris reports that leaders of the science establishment are now trying to figure out how to fix this broken system.

RICHARD HARRIS, BYLINE: Biomedical science has a long history of funding ups-and-downs, and the system has always righted itself with the passage of time and plumper budgets. But this time seems different if you ask some of the biggest figures in biomedical research.

HAROLD VARMUS: I'm Harold Varmus. I don't know how to introduce myself here.

HARRIS: Varmus heads the National Cancer Institute, but he's not wearing his official hat today. He's speaking out based on his own, deep experience in biomedicine. He won a Nobel Prize at UC San Francisco; he ran a major medical research institution - Memorial Sloan Kettering in New York.

You were the head of the NIH back in the late 1990s when the budget was double then. I wonder if you could tell me that story. It must have - for one thing it must have seemed like a wonderful idea when you managed to convince Congress to double the NIH budget.

VARMUS: Well, it wasn't me alone, and it has to be recognized that we actually weren't asking for that much that fast at that time, and many voices including my own were saying, you know, yes this is great. And we're looking to spend the money well, but you've got to be prepared for what you do at the end of that five years.

HARRIS: Doubling the budget would of course encourage rapid growth. So smaller, continual increases would then be required to keep this bigger enterprise humming. And the budget did grow to an impressive size - $30 billion, but with inflation it has been shrinking since - creating all sorts of hardships. Many scientists say the obvious solution is to give them more money.

VARMUS: There's no doubt that having a bounce back, an increase in our funding, would be helpful. But I don't think it's going to solve all the problems at this point.

HARRIS: There are now deep, structural problems. Scientists and universities alike are thinking less and less about the exciting frontiers of science and more and more about tactics they can use simply to stay afloat.

VARMUS: It is difficult to operate and difficult operate in an adventurous way.

HARRIS: Some people say, well, there were dips in the '90s and dips in the '80s and the NIH budget has always gone up-and-down. And so some people just yawn and say, well, we've been here before, and it doesn't seem that different. Is it different this time?

VARMUS: You know, I've lived through those; I know what they were like. They were never in my experience anywhere near as dramatic as they are now.

HARRIS: One of the biggest changes is and how NIH money is used. These days it's not simply to conduct experiments. It's increasingly spent on scientist salaries and even to repay the loans on new laboratory buildings that sprang up like mushrooms during the budget boom times.

VARMUS: Research is a very tricky business because we recognize that universities are under tremendous pressure. And states for example that have some of the best public universities in the country the amount of money that can be used to support research activities has declined precipitously.

HARRIS: So the NIH can't simply make bold, new rules about how these universities can spend grant dollars. Instead Varmus and his colleagues are stimulating discussions to figure out if there are more gentle changes. One idea is to reduce the number of young scientists being trained for careers that don't exist, and instead hire staff scientists to carry out more of the day-to-day lab work that the apprentices now perform.

VARMUS: Staff scientists don't necessarily have to have PhD's. They might have master's degrees, and being a staff scientist these days is quite an appealing way to practice science.

HARRIS: You can concentrate on doing the work and not get tangled up in the sometimes noxious process of fighting for funding. And Varmus says the NIH could also help some scientists avoid the money scramble by following the example of the Howard Hughes Medical Institute. This private philanthropy gives generous grants to individual scientists based on that person's broad ideas and talents rather than to fund a specific research proposal.

VARMUS: We have to remember here that this is a fragile system, and do no harm, the doctors mantra, is very applicable here.

HARRIS: How much can you as players affect this - fix the system?

VARMUS: Well, I think that remains to be seen. That's why we want to have these meetings because we want to bring together folks who are in government administration, scientific societies, advocacy groups, students, faculty, even members of congress.

HARRIS: Varmus would ultimately like to help convene a summit of all those interests, but in preliminary planning sessions there was no clear consensus. So, he says, they want the conversation to percolate for a while before they actually convene a big meeting. The issue is on the agenda this Friday for the White House Science Advisor's meeting.

VARMUS: We have a system that has worked well in the past and has made the U.S. the leader in biomedical research worldwide, and while I don't think we've lost that yet we do see a rising tide in lots of places.

HARRIS: Maybe eventually the threat of losing this competitive edge will spur Congress to address the underlying problems in biomedical research funding, but that appears to be a distant prospect. So the injunction physician heal thyself seems apt. The research establishment will try to figure out how to ease the pain on its own. Richard Harris, NPR News. Transcript provided by NPR, Copyright NPR.

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