How can we improve the NIH?

The NIH’s extramural research is systematically biased in favor of conservative research. This conservatism is a result of both institutional inertia, concerns by the NIH leadership that the organization could lose the support of Congress, and efforts by NIH beneficiaries to maintain the status quo.

The extramural grant distribution process, which is run through peer review “study sections,” is badly in need of reform. Though there is considerable variability among study sections, many are beset by groupthink, arbitrary evaluation factors, and political gamesmanship. The NIH may be hamstringing bioscience progress, despite the huge amount of funds it distributes, because its sheer hegemony steers the entire industry by setting standards for scientific work and priorities.

Most problematic, the NIH is highly resistant to reform. Many proposals have been shot down during discussion phases, or scaled back before implementation. The NIH’s own internal review board has been inactive since 2015, as mentioned at the start of this report section. Still, many of the NIH’s problems are likely a natural product of being a $40 billion+ per year government bureaucracy.

That is from Matt Faherty, and here is 33,000 or so words more on why the NIH is a good idea, what is wrong with the NIH, and how to improve it.  It is by far the best piece written on the NIH, and if it were to count as a book would be on the year’s “best of” list.

The piece is based on extensive interviews, and here is one reflection of that:

An anonymous comment on an NIH article reflected the sentiments of the most negative interviewees: 

“It is well known that NIH ‘confidentiality’ [of the primary reviewer to the grant applicant] is anything but, and a young PI risks career and reputation if they shoot down big names (not all, but there is a mafia of sorts). I’ve sat on panels, I’ve seen the influence from afar. Young PIs fall over themselves to get it good with the power brokers. I’ve seen young PIs threatened when they mentioned quietly that Big Boss X has data that is wrong. Some fields are worse than others, but it is overall a LOT uglier than most would believe.”

As for two meta-points, a) it is striking how little quality analysis of the NIH has been done, and b) how many of the respondents to this current work feared consequences for their careers, some responding only on an off the record basis.  I am proud to have supported this work through Emergent Ventures.

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