In his last blog post before resigning as director of the National Institutes of Health in December 2021, Francis Collins touted many of the important areas of research NIH conducted or funded in his more than 12 years leading the organization, “from innovative immunotherapies for treating cancer to the gift of mRNA vaccines to combat a pandemic.” He could have added to this list other frontiers of medicine explored by NIH-supported researchers: how the human brain works; the health benefits of the trillions of microbes that call our bodies home; and technological advances such as mapping the atomic structures of proteins, editing genetic material, and designing improved gene therapies. But while such a record deserves a victory lap, a full accounting of Collins’s tenure should also include a list of NIH’s longstanding shortcomings.
Most of NIH’s substantial budget goes to fund grant proposals from researchers at academic institutions around the country. Groups of experts on “study sections” rank these proposals on the basis of merit and feasibility. They make these judgments not competitively across all disciplines but instead divide the areas of research among NIH’s 27 components: cancer, aging, eye, nursing, allergy and infectious diseases, and so on. One of these areas of research, however, is not like the others—the National Center for Complementary and Integrative Health, which studies what is popularly known as “alternative” medicine. The NCCIH was the brainchild of politicians, not scientists, and remains the dirty little secret of the research community, Congress, and the NIH.
The stated mission of NCCIH is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.” But “complementary and integrative” often means implausible and unworthy. A large study by doctors at the Yale School of Medicine, for instance, investigated the impact of complementary medicine on patients with curable cancers, finding that it was actually harmful: “In this cohort study of 1,901,815 patients, use of complementary medicine . . . was associated with refusal of conventional cancer treatment, and with a 2-fold greater risk of death compared with patients who had no complementary medicine use.”
Because peer review at NCCIH is conducted by true believers within its own ranks, many of the projects funded are trivial or poorly designed, and most of the interventions tested have proved worthless. For example, a study supported by NCCIH found that a cranberry-juice cocktail was no better than a placebo at preventing recurrent urinary tract infections, though at the time the institute’s own website listed the results of many studies showing that the intervention was of limited value. Similar results hold for echinacea for colds, ginkgo biloba for memory, black cohosh for menopausal hot flashes, and shark cartilage for cancer—none of which worked in large studies. Other studies supported include “Long-Term Chamomile Therapy of Generalized Anxiety Disorder,” “The Use of Narrative in Public Health Research and Practice,” and “Restorative Yoga for Therapy of the Metabolic Syndrome.” These are the kinds of projects that get funded when the inmates run the asylum; they are a far cry from the medical triumphs Collins enumerated in his final blog post.
The more credible research studies funded by NCCIH could be evaluated more effectively by other NIH components, such as the National Institute of Neurological Diseases and Stroke or the National Institute of Mental Health, where they would be more rigorously peer reviewed. In 2020, the NIH could afford to fund only 20.6 percent of the investigator-initiated research grant proposals it received. The $138 million NCCIH budget is an affront to other NIH-funded researchers (and aspirants) who work at the cutting edge of their disciplines but face increasing difficulty getting federal funding, even for studies that rank high on scientific merit.
These dubious funding priorities have been lent a pseudo-legitimacy by an ongoing boondoggle that began in 1990 as part of the NIH’s Human Genome Project—a legislatively mandated set-aside of not less than 5 percent of the entire budget of the National Human Genome Research Institute for the Ethical, Legal and Social Implications (ELSI) research program. The program, which has awarded hundreds of millions of dollars in research support, has created a cottage industry among ethicists, sociologists, and other navel-gazers at the fringes of the research establishment. Most ELSI “research” wouldn’t have a prayer if it had to compete with “hard science” disciplines.
The tremendous benefits of basic research won’t come from spending on the kinds of projects favored by NCCIH and ELSI. So where should it be spent instead? Let me offer an example related to Covid-19. Politicians would have us believe that the pandemic was an unprecedented, unanticipated, and unpredictable bolt from the blue. Not true. The warning signs were ignored, and we were ill-prepared because we failed to fund the right research, at the right time, and in the right amounts.
As a review article in Clinical Microbiology Reviews concluded in 2007, “Coronaviruses are well known to undergo genetic recombination, which may lead to new genotypes and outbreaks. The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.” The article praised the research that had been performed quickly in response to the 2002–2003 SARS outbreak but observed that much more needed to be known: the molecular determinants of the transmissibility of the virus, the molecular and immunological basis of disease pathogenesis in humans, screening tests for early SARS cases, infection-control procedures for patient care, effective antiviral drugs or combinations, immunomodulatory agents, effective vaccines, and animal hosts.
When the SARS-CoV-2 virus emerged more than a decade later, the same gaps in knowledge remained, because the research community hadn’t intensively studied those issues, but the NIH (and its sibling, the National Science Foundation) frittered away significant amounts of research funding on low-quality boutique projects.
There’s another reason to spend research funds wisely. International research and development is highly competitive, and China is currently the world’s second-biggest spender on R&D—at $468 billion, versus the U.S. investment of $582 billion in 2018, according to the Organization for Economic Cooperation and Development.
We need to support basic research at a level sufficient to prevent America’s scientists and businesses from becoming also-rans in the technological fields that will keep the U.S. economy competitive. Doing so will require us to be more discerning about our research priorities. We can ill afford to fund projects simply because they are politically correct or a sop to lesser disciplines.
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