In a recent visit with The Chronicle, the director of the National Institutes of Health, Francis S. Collins, spoke of brighter days ahead for his agency and medical researchers after a decade of tough budgetary constraints.
The Obama administration has asked Congress to spend $31.3-billion on the NIH in the 2016 fiscal year, up about $1-billion from its current level, and Dr. Collins said there are signs that Congress may be ready to put the agency on a more sustainable financial path in the years ahead.
Dr. Collins also explained why the timing is now right for the “precision medicine initiative” proposed by the president, given advances in genetics and electronic medical records, and he envisions tough but steady progress in the NIH’s campaign to improve conditions throughout the life cycle of medical researchers.
PAUL BASKEN: Welcome, Dr. Collins. We have today Dr. Francis Collins. He's the director of the National Institutes of Health, the leading provider of research money to U.S. universities. Welcome, Dr. Collins.
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FRANCIS S. COLLINS: Well, certainly, everybody's hoping that we might turn the corner in what has been a pretty difficult 12 year period. As you know, we've lost about 25% of our purchasing power for biomedical research through NIH since 2003, with flat budgets being eroded by inflation, and then the particularly difficult, painful process called the sequester, which further damaged our ability to fund people, who have great ideas, who are out there waiting for some sign that things are turning around.
I'm encouraged by the president's putting out this $1 billion increase, 3.3%. Obviously, that is the opening bid, and the way our process works, all you can say is it's totally unpredictable. You mentioned that, sometimes, the Congress ends up cutting what the president puts forward. Well, yeah, but if you go back further, that's not always been the case.
And we have, obviously, a new game in town here, especially with the Senate now having different leadership than it did the last time we went through this, which was last year. I'm guardedly optimistic, Paul, because the one thing that people on both sides of the aisle and in both houses and in both branches seem to agree is that medical research is really important.
It's our best hope for answering many of the difficult challenges we have with health, and it's about the best way to stimulate our economy at the same time. So I think there is, at least, intellectual agreement that something out to be done to try to get NIH back on a stable trajectory, and that's not just coming from one party that's-- I've heard that from both.
The question is can we actually implement that at a time where we continue to have this difficult national conversation about the deficit and what we're going to do about our fiscal house.
PAUL BASKEN: One of the big headlines coming out this past week, or a week or so ago, was the Precision Medicine Initiative. It seems to fall along the lines of what you've been talking about already in some areas in terms of genomic medicine and electronic medical records. Maybe could you tell us what's different about this? And also, for the medical researchers, how do you get them to change ingrained behaviors that maybe this rubs up against? Where can the NIH push levers to make that happen?
FRANCIS S. COLLINS: Well, I'm pretty excited about this initiative. The time really seems to have come to bring together a whole host of developments that have been in the works, but are now lining up. You mentioned electronic health records, that's certainly one of them where it's possible now to begin to do large scale research without having to pour through paper records of people's medical history.
We have the amazing cost reductions in doing genome analysis from that original first genome of hundreds of billions of dollars down now to a couple thousand, and it's continuing to drop. And we have the opportunity also to begin to incorporate into this a whole host of new cellphone based gadgets that allow you to assess somebody's physiological status both as part of health maintenance, but also as management of chronic disease.
And very importantly, I think we have a gathering patient movement, a wanting to be involved to be participants in research and to be at the table, which we strongly encourage. Put that all together, and maybe we couldn't have done this five years ago, but maybe we can now. So what's it about? A lot of it is scale, really trying to do this because numbers matter.
If you're trying to figure out environmental exposures and genetics and medical experiences, well, how does that all fit? You need big numbers.
PAUL BASKEN: One thing I want to focus on though is the behavior-- like we go to a doctor's office, and they resist even giving us the records of our visits. I mean this is-- so it seems like there's a cultural resistance, and I'm wondering, how do you get past that? Does the NIH have a role in breaking that down somehow, and what would it be?
FRANCIS S. COLLINS: Well, we don't actually do health care delivery, but we do research on health care delivery. And actually, if you could imagine this million strong cohort that we hope to put together over the next couple of years, many of the participants in that are going to be health care delivery systems. Kaiser Permanente is really interested in this, so is Mayo, so is Marshfield so is Geisinger.
If we could have those kinds of health care delivery systems not only doing the research, but because their medical professionals are part of the scene, actually changing their practice behaviors because they have the chance to be part of this experiment, that might be pretty useful as something where you could, in a more rigorous way, assess how to incorporate what we're learning into medical practice and not just hope it happens in the next 20 years.
PAUL BASKEN: Another area the NIH has been pushing for a while is on this issue of the life cycle of the investigator, of a researcher. I know you've obviously been very concerned for awhile about the fact that it's 40 something before a researcher gets their first independent grant. You've been trying to figure out ways maybe to help researchers at the older age figure out a reasonable way to wind down their careers.
You've been working hard on issues of gender differences, racial differences, but you've been working on it for a long time. It's a tough problem. Is there any hope that something will change fairly soon in these general areas?
FRANCIS S. COLLINS: It is a tough problem, and it's made particularly tough by the really difficult resource constraints. I mean we are at historically low levels of success for grand applicants actually getting funding, and that's something for which it's hard to come up with magic to really fix that. And if you're a young investigator now trying to get your lab up and going, you're facing this one chance in six that your application might get funded.
We're trying to do everything we can to encourage people in that situation so that young investigators, first time investigators, compete against each other instead of against the more experienced one. That's been a pretty successful effort over the last six or seven years. We are pushing such things as the Early Independence Award, giving particularly gifted doctoral trained researchers the chance to skip the post-doc and go straight into an independent position.
There's a lot of discussion about whether we ought to shift more of our portfolio from the traditional RO1 and into awards that are more like the Pioneer Awards where you give investigators more flexibility, but also you have a chance, therefore, to cut back the number of grants that that person is constantly writing and rewriting and resubmitted and let them actually do the work instead.
That might spread the wealth a bit if we can see that happen. NIGMS is moving in that direction quite rapidly. This business of older investigators, many of whom are very productive, and we don't want to do anything to discourage that, but at the same time there may be a need to figure out ways for those who are ready to move into some other phase of administration or mentoring or teaching or some other new career path, to come up with a smooth fashion of doing that as opposed to this very hard stop that sometimes now happens when your grant doesn't get funded and your lab's in trouble and there are trainees who are caught in the middle.
Maybe we could come up with a way of a more graceful passage into the next phase of somebody's career, but I don't think we know yet exactly how to do that. Howard Hughes has a program like that. We're looking to see what their experience has been and trying to learn from that.
PAUL BASKEN: Thank you, Dr. Collins, appreciate you visiting with us today.
FRANCIS S. COLLINS: It's been great to be here.