Growing a better NIH

A radical way to fix the nation’s medical-research establishment

June 19, 2011|By Michael M. Crow

The United States spends around $30 billion a year on the National Institutes of Health, an agency that has been called the “jewel in the crown of the federal government.” The NIH is by far the nation’s most important single funder of medical research — the scientific work that drives our university labs, our drug companies, and our major hospitals — and its budget amounts to an enormous bet that by advancing basic medical science, we can reap improvements in national health care.

In one arena, at least, that bet is paying off: America has become the unquestioned global leader in biomedical science. As it has, the NIH has also become critically important to states like Massachusetts, which reaped more than $2 billion in funding last year, fueling a high-tech economy of high-paying jobs.

But biomedical science is not the same thing as health, and in a very important sense, our investment in the NIH is not fully paying off. The agency’s own mission statement holds that its ultimate goal is applying knowledge to “enhance health, lengthen life, and reduce the burdens of illness and disability.” And on that count, America is doing less impressively. Among the large industrialized countries of the Organisation for Economic Co-operation and Development, the United States spends the most money on its health care both as a share of gross domestic product and per capita, according to a 2009 report — but our life expectancy ranked 24th of the 30 countries in the report. And on numerous other measures — including infant mortality, obesity, cancer survival rates, length of patient stays in hospital, the discrepancy between the care of high versus low income groups — the country fares middling to poor. Our global leadership in research, in other words, has not translated into leadership in health.

To tackle this problem, NIH director Francis Collins made news six months ago by announcing a new “translational research” institute dedicated specifically to converting laboratory findings into medicines and diagnostics that real patients will use. Its supporters hailed the idea as an important step; others in the research sector objected, worried about its impact on the current structure of an agency their work depends on for funding.

But in a larger sense, his proposal — which would create a 28th institute within the NIH bureaucracy — amounts to an admission that America’s medical research establishment is insufficiently focused on outcomes beyond science. For all the money America spends on medical science, its innovations aren’t really improving our health as much as we would hope.