On March 3, National Institutes of Health (NIH) director Francis Collins and five of the NIH’s 27 Institute and Center directors made their first appearance before the new chair of the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies (Labor-HHS), Tom Cole (R-OK). Full Appropriations Committee chair Harold Rogers (R-KY) was also in attendance.
Cole thanked Collins and the staff at NIH for hosting him and five other subcommittee members for a briefing tour of the NIH campus stating that he “left the NIH with a deeper appreciation” of the agency. The new chairman noted that the directors are “at the helm of research at the NIH during a time that demands our country’s interest and investment in medical research.” He also pointed out that it is important that the Congress continue to focus on the next generation of investigators. Noting however, that Congress supports biomedical research, Cole stated that “sequester is the law of the land and given the reality of funding allocations, we might not be able to do everything that the administration is proposing absent a larger bipartisan agreement.”
Collins was joined by Anthony Facui (NIAID – National Institute of Allergy and Infectious Diseases), Tom Insel (NIMH – National Institute of Mental Health), Jon Lorsch (NIGMS – National Institute of General Medical Sciences), Nora Volkow (NIDA – National Institute on Drug Abuse), and Gary Gibbons (NHLBI – National Heart, Lung, and Blood Institute).
Chairman Rogers added that in addition to the “public health benefits that accompany NIH work, the economic impact of medical research should not be underestimated.” He made special note of the work of NIDA, stating that Volkow “has been a true pioneer in the science of drug abuse and addiction,” including being one of the first scientists to use brain imaging to investigate the effects and addictive properties of drugs of abuse. He thanked Volkow for her efforts in battling prescription drug abuse, “a scourge that is killing more Americans than car accidents.” Rogers also noted that he was pleased that NIDA, under Volkow, is pursuing the so-called ABCD (Adolescent Brain Cognitive Development) study. Citing the lack of scientific data to tell us about the long-term impacts of marijuana use on the brain, he explained that the ABCD study is designed to collect “rigorous longitudinal data on the effects of marijuana, alcohol, nicotine, and other drugs” on young peoples’ brains.
Subcommittee Ranking Member Rosa DeLauro (D-CT) called for investing in the NIH, noting that it is “deeply troubling” to her that since 2010, after adjusting for inflation, NIH has seen its budget erode by 11 percent (about $3.6 billion). She further noted that the agency’s budget has not returned to its pre-sequestration level even after modest increases over the past two years. The President’s budget request, said DeLauro, starts to put the agency back on the right track. “But given this severe neglect of NIH over the past few years, I am disappointed that we are not restoring funding more quickly,” she added.
Collins testified that the NIH remains strongly committed to basic science and cited the BRAIN initiative as an example. He also noted the agency’s leadership role in the multi-agency Precision Medicine Initiative (PMI). He explained that in the near term, the PMI will focus on cancer. A longer-term goal is the launch of a national research cohort of one million or more volunteers “who will play an active role in how their genetic and environmental information is used to prevent and manage a broad array of diseases.” According to the director, “a project of this magnitude will lay the groundwork for new prevention strategies and novel therapeutics.”
Responding to Cole’s inquiry as to what he was doing now to make sure that we engage the next generation of scientists, Collins explained that NIH tries to make a special effort to fund the first application from a new investigator. The agency is also funding a program that provides support for post-doctoral fellows who are ready for an independent position to compete for their award and carry part of that award to an academic position, known as the K99 awards. The agency is increasing its support for the award.
NIGMS director Jon Lorsch shared details of NIGMS’ new pilot program called the “Maximizing Investigator’s Research Award” (MIRA). Lorsch explained that MIRA’s fundamental goal is to improve the efficiency of NIH’s funding mechanism, which would increase the ability to distribute funds, especially to young investigators. One of the targets for MIRA is improving the stability of funding for investigators. In addition, it would improve the flexibility for investigators to “file in new research questions as they arise” along with their ability to take on ambitious research projects and follow them in a creative manner.
Rep. Mike Simpson (R-ID) inquired as to whether or not the Personalized Medicine Initiative would be extended to less lethal diseases. Responding, Collins explained that PMI would allow the NIH to study virtually all diseases via the one million cohort, including such things as periodontal disease or dental caries, because there is an environmental and genetic risk involved in those conditions. The problem has been the lack of a “sufficiently large study with appropriate patient participation to be able to get those answers.”
Noting that she would like to see the NIH’s budget doubled, Rep. Barbara Lee (D-CA) expressed her pleasure in seeing a proposed increase for HIV/AIDS research and the National Institute for Minority Health and Health Disparities (NIMHD). Lee expressed her support for NIMHD’s focus and examination of the “social determinants of health…because we know many of the health disparities in minority communities directly relate to the social determinants.”
Rep. Steve Womack (R-AR) noted that Arkansas, which has a “lot of underserved populations” is one of the states benefiting from the IDeA [Institutional Development Award] program. He further noted that he is aware that a lot of Arkansas’ applications “go wanting” and it is something he would like to improve. He asked about the level funding requested by NHLBI for IDeA in FY 2016, to which Gibbons explained that the program received a $50 million increase in FY 2011, which means that it actually has grown more rapidly over a five-year period than the rest of NIH. Lorsch further explained that the IDeA program is now housed at the National Institute for General Medical Sciences (NIGMS), and that the institute is “completely committed” to the goals of the program.
Rep. Chaka Fattah (D-PA) noted that the Congress provided additional funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) and directed it to work with the National Institute of Mental Health (NIMH) to help states implement programs also known as RAISE (the Recovery after Initial Schizophrenia Episode) “that have proven effective in terms of preventing the first episode of psychosis.” Insel noted that RAISE is a program initially funded via the American Recovery and Reinvestment Act of 2009 (ARRA), adding that there are pilot programs developed in collaboration between NIMH and SAMSHA in all 50 states.
Noting that Collins expressed concern regarding the amount of funding going towards international research and maintaining American competitiveness, Rep. Chuck Fleischman (R-TN) asked what NIH is doing to take advantage of the research being done in other countries. Collins responded that the country that leads in biomedical research enjoys other benefits rather directly, especially in terms of commercial spin offs. He noted, however, that the NIH has lost about 22 percent of its purchasing power for biomedical research since 2003, which has resulted in a very substantial downturn in terms of what the agency can support. At the same time, other countries are increasing their support for biomedical research. Noting that a doubling of the agency’s budget would be a nice thing, what would be better, Collins asserted, would be stable, sustained funding.
Rep. Lucille Roybal-Allard (D-CA) requested an explanation for the discontinuation of the National Children’s Study (NCS), stating, “Congress fully expected that the study would be carried through to its completion… In almost every fiscal appropriations report from the year 2000 to 2014 there have been specific instructions from both the House and the Senate directing the continuation of the Study.” She wanted to know “by what authority did [NIH] use to disband the study, whose authorization is still current law and for which Congress has spent $1.5 billion over the last 15 years.” Collins responded that it was one of the more difficult decisions he has experienced as the NIH director. It became increasingly clear that the design of the NCS was not fitting the way in which technology was developing over the course of the last 20 years. Congress, in the Omnibus Bill, he explained, gave the agency the opportunity to take the $165 million in the FY 2015 budget and think of new ways that the NIH could obtain answers to these questions regarding the environment in pediatric health. The agency expects to announce what those programs will be in FY 2015 in the very near future, adding that he thinks the Congress will find them to be “quite innovative.”
Rep. Scott Rigell (R-VA) who recently transitioned from the House Armed Services Committee and whose district has the “highest concentration of men and women in uniform,” inquired about the extent to which NIH is prioritizing PTSD. Responding, Insel explained that NIMH was founded in 1946 and charged in 1949 to deal with problems of veterans. The Institute has been working closely with the Department of Defense and is gaining insights regarding the cause and the best interventions to make sure that people who develop mental health problems do not go on to suicide.
Responding to Rigell’s question on NIH priority setting, Collins noted that the agency is constantly analyzing its research portfolio, including examining the needs, scientific opportunities, and gaps. He cautioned, however, that if the Institute did everything on the basis of public health need, it would probably neglect the rare diseases. It is a constant recalculation, said Collins.