Flap Over ‘Public Science’

New labs and clinics are sprouting across the leafy Maryland campus of the National Institutes of Health, courtesy of infusions of cash from Congress. Legislators excited by biotechnology’s promise of curing disease have doubled the research agency’s budget in the last decade, with last year’s 15% boost bringing the annual budget to $15.7 billion.

Now, however, some lawmakers are having second thoughts about flinging new money at one of Washington’s most loosely regulated agencies. Senate Budget Committee Chairman Pete V. Domenici (R-N.M.) leads a group of legislators who are asking NIH Director Harold Varmus to help devise accountability measures to ensure that taxpayer dollars are well spent. Unfortunately, Varmus, who has led the NIH since 1993, bristles at the notion of legislators overseeing research. As a result, say his critics, he had better brace for a zero increase this spring.

The first point of friction is the wild variance in funding to study specific diseases, traceable more to who has the most aggressive lobbyists than to which disease claims the most victims. In 1997, for instance, the NIH spent $1.8 billion (or $2,403 per patient) on AIDS research but only $313 million (or $19.58 per patient) on diabetes research. Varmus argues that spending on one disease may well benefit victims of other disorders. But the NIH needs to show that it has weighed the burdens and costs of particular diseases against the resources devoted to them.

A second and more serious problem is economic ties between NIH researchers and big drug companies, which some critics charge amount to payoffs. Earlier this week, for example, a Times report showed how the agency’s top diabetes researcher was accepting payments from at least four pharmaceutical companies that stood to gain from NIH research he directed, a clear ethics violation.

There are also more subtle conflicts. The NIH’s cliquish “peer reviewers” are often elite university researchers who may favor studies that, by proving the effectiveness of brand-name pharmaceutical drugs, bring in loads of drug company grant money for their academic departments.

The tide of money may be leading the NIH to focus too narrowly on curing diseases through drugs, thus failing to explore other ways of enhancing public health--through alternative medicine, for example, or understanding the roles of poor nutrition and stress.

The NIH should first draft sharper ethics rules, but it should also reconsider its larger mission. The U.S. government used to be science’s biggest benefactor. No more: Private investments in science by pharmaceutical and other interests now dwarf those of Washington. Some researchers critical of the system make a good argument that since private dollars tend to flow to scientists promising to show the efficacy of drugs, the government ought to focus more funding on the inefficacy or dangers of drugs.

Medicine is more than the latest biotech project or costly drug. The NIH needs to concentrate on less lucrative avenues to health, precisely because no one else will.