Biomedical Spending

I have traveled a lot in recent months, from Phoenix and Salt Lake City to Budapest and Amsterdam. I even purchased a world map, one of those for putting up on your wall, so that my children know where I’m calling from. Visiting places and talking with many people, I have a sense that some things never change, such as Vesúvio and patê of foie gras in Strasbourg.

Meanwhile, U.S. biomedical science, also very famous throughout the world and a reason for national pride, does not remain as I found it nearly nine years ago, when I moved to Boston. Today, the biomedical sciences are suffering because of the budget freeze at theNational Institutes of Health (NIH), the principal financing agency for biomedical research in the United States. As a result, the success rate of research proposals declined dramatically, in some cases up to 50 percent! That results directly from the will of the White House, with the conniving of the Republican and Democratic leadership in the U.S. Congress. The George W. Bush administration reduced income tax, but there has been an astronomical increase in spending on the war in the Middle East and protection against terrorism, leading to reallocation of resources within the federal budget and increase in domestic debt.

It is no secret that, in contrast to this reality, the biomedical sciences are not well positioned in the list of priorities of the current administration. And it is not yet clear how much the return of Democratic control of Congress can reverse this situation. The crisis is not limited to the United States. Even laboratories in Europe feel it directly or indirectly, given that a budget of US$28.5 annual billion cannot be rocked without vibrations being felt in the four corners of the planet.

on March 10, 14 middle and high school teachers from seven metropolitan school districts and a community college participated in a day-long curriculum workshop hosted at drCL aS, “Music, Land and Women’s rights: Citizens Making Change in brazil and the u.S.” the innovative curriculum, developed by jeffrey W. rubin, associate professor of history at boston university and his high-school-age daughter, emma Sokoloff- rubin, challenges students to grapple with pressing global issues while encouraging them to become active citizens. the curriculum’s 15 detailed lesson plans highlight brazilian social movements and activists via readings and audiovisual materials and relate the themes to issues of citizenship and activism in the united States. during the workshop, participants engaged in debates, role playing, and discussions and brainstormed techniques to use in drawing parallels between brazilian social movements and issues and organizations in their local schools and communities. the workshop formed part of drCL aS’s outreach effort to educators to promote learning and understanding about Latin america, and was sponsored by the u.S. department of education as well as the jorge paulo Lemann fund. top photo: Marie Lourdes elgirus, director of international education, Massbay Community College (MCC) (at blackboard) with jane a. Carreiro, department Chair, World Languages and paul elias, portuguese teacher, both from dartmouth high School. Center: jeff rubin and emma Sokoloff- rubin (workshop leaders); bottom: Susan Clark, Milton public School (at board) with ed McCourt, history/geography professor, MCC, Shahnaz kushki, bedford Middle School (on left), and kathleen M. ennis, executive director, primary Source.

Not even North American researchers who have the support of other agencies or private entities, such as the prestigious Howard Hughes Medical Institute, can do without NIH resources. They prefer to maintain ties with the federal agency in order not to lose proficiency in the art of writing research proposals and, logically, for the eventuality of cuts in their projects.

The results of this crisis are more profound than one can imagine, taking into account the Brazilian reality. That is because in the United States the majority of scientists in the biomedical area depend on the NIH federal aid, not only for the procurement of research inputs, but also for the financing of their own salaries and of the individuals who are part of their groups. Generally, in most U.S. universities, a scientist has to bring nearly 50%-60% of his or her salary from the outside (from the NIH, for example), with the host university paying the remaining portion. The interesting thing is that the proportion of the salary paid by the research institution is inversely proportional to its prestige. In the hospitals affiliated with the Harvard University Medical School, for example, the fraction is zero in the vast majority of cases, while in other universities that are less known or more distant from large economic and cultural centers, it can be up to 90%. Therefore, the reduction in the approval rate of research aid requests has a profound and immediate impact on the life of the scientist. The non-renewal of a project represents an immediate cut in expenditures and means loss of research team members, as well as, ultimately, the loss of the scientist’s own employment.

This mechanism is not new and works basically as a form of natural selection, since it promotes—without internal conflicts in the university—the exit of the least fortunate scientists and the permanence of the successful. One of the objectives of the university is to form the best possible team of researchers, composed of professionals who bring millions of dollars in resources for the university (indirect costs) and that do not need bridge support. This is a financial support provided by the employing institution for researchers who lose their research projects, so that they can maintain their salary and a minimum of laboratory support until the scientist has a chance of resubmitting his or her proposal to the NIH. One myth that is told around here is that, despite having boundless provisional bridge support, a full professor of the Harvard University Medical School has never requested such support from the university.

According to Andrew Marks, editor of the Journal of Clinical Investigation, besides the budget freeze, the NIH was also a victim of the implementation of a new master plan created by Elias Zerhouni, its director. According to Marks, the master plan promoted the displacement of resources destined to projects initiated by scientists, known by its acronym R01, for multicenter clinical research projects. The R01 is a time-tested and very successful mechanism, considered the fundamental basis of the research resources offered by the NIH. An R01 provides, to only one scientist, between US$200,000 and US$250,000 yearly, over a period of four to five years. At the same time, the institution that employs the scientist receives, directly, a technical reserve that can reach up to 75 percent of the value granted to the scientist. This aid mechanism is so important that the acquisition of a first R01 is a milestone in the academic career of the scientist, representing the transition to scientific independence and an implicit certificate of capacity and professionalism. The fact that the R01 is under the individual control of the scientist ensures the necessary freedom for creativity and innovation, placing the decision-making power and the use of resources in the hands of the scientists, far from administrative hierarchy and bureaucracy.

The multicenter projects, favored by the Zerhouni plan, involve major groups of researchers in different research centers and can exceed the mark of US$400 million. In these major projects, the decision-making power remains concentrated in the hands of a few scientists and administrators, who can be—and are—easily influenced by the NIH at different levels. Marks’ declarations triggered a reaction in defense of Zerhouni from all of the directors of the institutes that compose the NIH.

The deputy director of the NIH’s extramural research program, Norka Bravo, denies that the new master plan has caused a decrease in the success rate of scientists and that resources are being removed from the R01’s program. She explains that the crisis is the result of an increase close to 25% in the number of research solicitations in the last three years, a period in which the NIH budget remained frozen.

Even under normal circumstances, to obtain one R01 is difficult. Four or five years ago, an R01 was approved if it were classified in average among the 20% best. Scientists’ projects are evaluated by so-called study sections, a coordinating body of some twenty specialists in a given field. Today, in the study sectionof cellular and molecular endocrinology, of which I am a part, only a classification among the top 10% is guaranteed approval. That represents a brutal change in the success rate, mainly hurting young scientists, less experienced in the process of submitting research proposals, and privileging nuclei of excellence.

Those scientists who have their proposals classified between 10% and 20% are not happy, since their projects are declined even without major objections on the part of the study section. The loss of one or more proposals qualifies the scientist for bridge support. Never, in recent times, have we spoken so much about bridge support. This mechanism, that traditionally has transiently helped scientists, is clearly limited and incapable of adjusting to the current crisis. Successive failures discourage the institution to maintain bridge support and the scientist inevitably ends up having to seek new employment.

At the moment, the NIH and the research institutions are engaged in a tug-of-war in regards to the allocation of resources destined to bridge supports. That is because in several sectors of society, including the NIH, there is the perception that the research institutions are enriched by many years of indirect costs. This pressure by the NIH can function temporarily, but, little by little, the scientist ends up losing. Those who do not succeed in renewing their research projects are being forced to seek other positions in institutions with less prestige, that offer greater salary counterpart, with only those who succeed among the best 10 percent remaining. Organized movements exist in scientific societies in order to protest and even assist with some bridge support.

It is certain that the worst is still to come, since the 2007 federal budget, approved by Congress, contains no increase in resources destined to the NIH. If this pattern continues, the existence itself of the profession of biomedical scientist can be compromised once the possibilities of professional success, already slim, remain increasingly distant. At the end of the day, how can you attract a young person to a profession where his professional success depends on his lifelong permanence among the top 10%?