In House Hearing, NIH Director Collins Focuses on Patients and Researchers, Responds to Questions About the Trump Administration’s FY2018 Budget Proposal

Legislative Update
May 17, 2017

NIH Director Francis Collins, M.D., Ph.D.

On May 17, the House Labor, Health and Human Services, and Education (LHHS) Appropriations Subcommittee held a hearing with National Institutes of Health (NIH) Director Francis Collins, M.D., Ph.D. and members of his senior team (see box below), which followed a March 29 hearing with Department of Health and Human Services Secretary Tom Price, M.D.

In his Opening Statement, Subcommittee Chair Tom Cole (R-OK) said he was proud that Congress increased NIH’s funding by $2 billion in the Fiscal Year (FY) 2017 Omnibus spending bill, in addition to its December 2016 passage of the 21st Century Cures Act. As recently as May 10, he commented in a letter to the Wall Street Journal that, “NIH is a nonpartisan issue…In an era when Congress is divided and polarized, this is a cause in which Republicans and Democrats can work together for the good of the American people and to the benefit of the American taxpayer.”

He expressed his disappointment in the Trump Administration Budget Blueprint’s proposed $5.8 billion NIH cut stating that, “I am concerned that the reductions in the request would stall progress that our recent investments were intended to achieve and potentially discourage promising scientists from entering or remaining in biomedical research.” Those sentiments were greatly amplified in comments by Subcommittee Ranking Member Rosa DeLauro (D-CT) and House Appropriations Committee Ranking Member Nita Lowey (D-NY), who each detailed the impact of the proposed Trump budget cuts on their states in terms of reduced grant funding and economic impact, based on a recent study issued by United for Medical Research. Cong. DeLauro stated that, “I am almost inclined to dismiss the Trump budget, but I cannot. There is no defending this proposal, as the discussion should be about increasing NIH’s budget.” Cong Lowey stated that, “The Trump budget is a slap in the face to the scientific community and to the men, women, and children whose lives are being saved by NIH research.” Each also expressed their concern about a potential funding cut’s impact on early-stage investigators.

In his testimony, Dr. Collins presented “triptych” slides in which he described a disease, the patient being treated for it, and the NIH-funded investigator whose research has resulted in that successful treatment. Highlights of his answers to subsequent questions from Subcommittee members appear below:

• In responding to Chairman Cole’s question about how NIH-derived treatments and cures are “bending the curve” in terms of reducing or delaying health care costs, he cited the one-percent decline in cancer mortality each year during the past twenty years, as well as the 70 percent reduction in heart attacks and strokes over the past forty years. Citing both Alzheimer’s disease and diabetes, he emphasized the challenges the United States faces in terms of the potential annual cost of each disease by year 2050—Alzheimer’s alone increasing from $259 billion in 2017 to $1.1 trillion by 2050.
  


• When asked by Chairman Cole as to whether sustained increases for NIH or a budget doubling are more beneficial to NIH—and to early-stage investigators—Dr. Collins emphasized that a “stable, predictable trajectory is preferable, versus a ‘roller coaster’ approach.” He said that the FY2016 and 2017 increases reflecting biomedical inflation plus roughly five percent growth have been most beneficial.
  


• When asked by Cong. Lowey as to whether the private sector could “pick up the slack” on basic research, Dr. Collins described a May 8 White House meeting that engaged representatives of the business and investment communities, NIH, and FDA—at which industry acknowledged it does not conduct basic research due to stockholder pressure for commercialized products. Dr. Collins described the U.S. biomedical research enterprise as an “ecosystem” that is the envy of the world but possibly overtaken by China in the near future due to that country’s level of investment.
  


• Dr. Collins responded to several questions about NIH’s May 2 release of a new policy that restricts the amount of funding that an individual scientist can hold at any one time, based on a metric called the Grant Support Index (GSI). Although he cautioned that many details still need to be resolved (for example, exceptions), he said that this move is part of an ongoing effort to make obtaining grants easier for early- and mid-career scientists.
  


• In response to several questions about indirect costs in NIH grants—concern about which was expressed by Secretary Price at the March 29 hearing in regard to the cost to taxpayers—Dr. Collins described the value of indirects in covering specific academic institution expenses (facilities and administration, security, regulatory) and generally with respect to these institutions training the next generation of scientists. He noted that the government grant 30 percent indirect cost rate derives from Office of Management and Budget (OMB) negotiations every four years. He added that private funding foundations may have lower indirect cost rates in grants that they award since they may be able to absorb these costs—unlike an academic institution with a significant infrastructure.

Full Trump Administration budget details are expected on May 23.