At Moment of Danger, NIH’s Director Is Seen as Its Chief Protector

Appearing before Congress at the start of the budget season, the director of the National Institutes of Health made clear he did not agree with his own president on how much money the NIH needs.

“What will happen,” the NIH director said of the limited budget proposal for his agency, “is that some projects will not get funded. And many things that could go quickly will go less quickly.”

In the end, Congress largely sided with the director, granting the NIH $13.7 billion, far closer to what the director suggested than what the administration had requested, and kicking off a six-year doubling of the agency’s budget.

That was exactly 20 years ago.

The NIH director was Harold E. Varmus, the president was Bill Clinton, and the congressional hearing was led by Rep. John Edward Porter, an Illinois Republican who repeatedly prodded Dr. Varmus to ask for more money.

In the aftermath of the Trump administration’s shocking request this month that Congress tear apart the NIH structure and slice the agency’s budget by 18 percent, it’s one of the most appealing precedents some science advocates can imagine at the moment.

The current NIH director, Francis S. Collins, is an Obama administration appointee who repeatedly led the previous president’s calls for strong and sustained increases in federal support for science.

Now representing the Trump administration, Dr. Collins has allies confident that in a year of unimaginable political events, his status as one of the new president’s highest-ranking voluntary holdovers can not only straddle the ideological chasms before him but largely save the NIH in the process.

Dr. Collins was due to testify this past week before the House Appropriations subcommittee once led by Mr. Porter. The appearance was canceled without explanation, in what committee Democrats described as a tacit admission that Dr. Collins wouldn’t be able to justify cutting $6 billion from the NIH’s $32-billion annual budget.

When he does eventually explain the situation to lawmakers and to the public, said Kathy L. Hudson, a former chief of staff to Dr. Collins who served in top NIH positions throughout the Obama administration, Dr. Varmus’s performance in the Clinton administration will be an important precedent.

Ms. Hudson said she expects Dr. Collins to describe to Congress the NIH’s success, avoid mentioning specific dollar figures, and respond as members “in a very thoughtful and statesmanlike way” ask him questions that he can answer in a way that would not “result in a hand slap” from the White House.

Another longtime Obama administration colleague, Kei Koizumi, agreed that Dr. Collins would be able to win the support of lawmakers — even in a Congress led by Republicans determined to shrink government programs — for a much more reasonable NIH budget than the president has requested.

“Dr. Collins has always been a little bit unusual,” said Mr. Koizumi, a visiting scholar at the American Association for the Advancement of Science who until recently served as a White House science adviser under President Obama. “Even in the Obama administration, he was never reluctant to express his regret or his disappointment with the president’s budget.”

A Big Ask

In a different era, Dr. Varmus did something similar. The Clinton administration in 1997 asked Congress for a budget of about $13 billion for the NIH in the next fiscal year, up 2.6 percent from the current year. Appearing before Mr. Porter’s subcommittee, Dr. Varmus also described a “professional judgment” budget of nearly $14 billion, representing what top NIH officials regarded as the optimal level of spending based solely on an assessment of the science.

Dr. Varmus declined this week to comment on the predicament facing Dr. Collins. But in his 2009 book, The Art and Politics of Science, Dr. Varmus recalled welcoming the opportunity “to make my own heretical appeals for more than the president had requested for the entire NIH.” He said he realized that administration officials were monitoring his presentations, but concluded: “It is better to apologize later than to ask permission first.”

The NIH continued to produce professional-judgment budgets at least through 2015 when he left the agency, Dr. Varmus said. An NIH spokeswoman said, however, that there is not currently an agencywide professional-judgment budget and that it’s been at least a decade since one was last produced.

Either way, Dr. Collins would have to be cautious about presenting such an estimate to Congress, said a member of his official NIH advisory panel. Federal law restricts the ability of government officials to lobby Congress, said M. Roy Wilson, the president of Wayne State University. Therefore, Dr. Wilson said, an NIH director asking lawmakers for more money than the administration requested — without them asking first — might be a violation.

Yet the proposed 18-percent cut is obviously far deeper than anything the NIH could sustain simply by finding greater operating efficiencies, said Dr. Wilson, who serves on the NIH’s Advisory Committee to the Director. “An 18-percent cut is not tenable for anybody — it’s just not possible,” he said.

That assessment represents the overwhelming consensus of the university and scientific community. The administration’s proposed cuts in the budgets of the NIH and other science agencies don’t seem to have any empirical basis, said Mr. Porter, who now serves on the board of Research!America, a lobby group representing academic and corporate backers of research. “I think they just pulled them out of the air,” he said.

But the administration’s plan for the NIH may have at least some allies in its corner. Arizona State University’s innovation-minded president, Michael M. Crow, called in 2011 for the NIH to be cut down from 27 institutes and centers to just three. Mr. Crow doesn’t support cutting the NIH’s budget, but he still believes the agency’s structure could be made a lot simpler and more efficient, a spokeswoman said.

And Susan M. Fitzpatrick, president of the James S. McDonnell Foundation, has been suggesting to members of the scientific community in recent days that they should stop their “knee-jerk” insistence that NIH couldn’t stand at least a little slimming.

Ms. Fitzpatrick cited a series of high-profile complaints about biomedical science — including lack of reproducibility, failure to concentrate on patient-level applications, and overproduction of researchers — as reasons to question whether the NIH needs a thorough overhaul rather than more “tweaks,” and whether Dr. Collins is the right person to accomplish that after eight years as its chief.

“The first reaction of the biomedical community is always to ask for more,” she said. “It’s never to look inward and say, Are we using the funding that we’re currently getting to the best of our abilities?”

A Different NIH

Dr. Collins’s allies firmly rejected that contention. Ms. Hudson listed a series of instances in recent years where the NIH had made important changes based on detailed studies of its practices, including an overhaul of the National Library of Medicine, a retooling of the NIH’s data-sciences programs, and the elimination of the National Center for Research Resources.

The NIH is far different from 20 years ago, said Dr. Wilson, recalling his time as a grant reviewer when the agency provided him lunches and full-fare flights. Now, he said, the NIH insists on budget airfare and won’t even provide its guests with coffee. “It’s downright embarrassing,” he said, describing the treatment of foreign visitors who offer NIH representatives far greater hospitality in their home countries.

And to any degree that the NIH’s 27-unit structure may be unwieldy, Ms. Hudson said, it’s a result of lawmakers insisting on dedicated streams of funding for particular disease categories they care about. But even with that, she said, the institutes have now created highly effective systems for analyzing and coordinating grant awards.

This past week’s failure by the Trump administration to kill off the Obama-era health care system is a good reminder, several NIH allies said, not to be too alarmed by the administration’s stark budget proposal. “It’s hard to get really agitated about things until things play out a little further,” said Linda G. Griffith, a professor of biological and mechanical engineering at the Massachusetts Institute of Technology who also serves with Dr. Wilson on the NIH director’s advisory panel.

And Dr. Collins, at such a critical moment, plans to stick around. Mr. Porter said Dr. Collins recently described meeting with both the president and his chief strategist, Steve Bannon, and reported that “they seemed pretty good” with him remaining as NIH director. “He clearly wants to stay there,” Mr. Porter said of Dr. Collins.

Paul Basken covers university research and its intersection with government policy. He can be found on Twitter @pbasken, or reached by email at paul.basken@chronicle.com.