Dr. Varmus Describes Life on the NIH Budgetary 'Roller Coaster'

NEW YORK--What with inflation, budget cutting, burgeoning grantapplications, and dueling disease advocacy groups, it isn't easybeing director of the National Institutes of Health. Harold E.Varmus, MD, gave an audience at the Irvington Institute a peekat what he is up against.

First, he must deal with the lengthy federal budgetary process:"I negotiate with the directors of the Institutes, then withthe Department of Health and Human Services (HHS); then HHS goesto the Office of Management and Budget. We also negotiate withthe White House Office of Science and Technology."

The President's budget has to be approved by a Republican Congress,"so we have to go to various House and Senate committeesto get our appropriations. These appropriations ultimately comefrom subcommittees that have jurisdiction over other well-intentionedprograms such as education and labor, so we are competing forthe same money."

This year's budgetary process was a roller coaster of unprecedenteddifficulty, he said.

The new NIH budget is $11.9 billion. "Yes, that's B for billion,"Dr. Varmus said. Most of it goes to researchers in 1,700 universitiesand centers across the country; 10% goes to government NIH scientists.Some has already been promised to research projects that lastfor several years.

Although in real dollars the NIH annual budget has gone up, itsbuying power has remained static for several years because ofthe 4% inflation rate, Dr. Varmus said. Combine these factorswith increasing number of grant applications and plans to cuta third of the NIH budget, and there is a real threat to the nation'sresearch infrastructure, he said.

The bottom line is that the Institute needs fewer grant applicationsand more supporters, he said. "Biomedicine is very attractivethese days. It's in a period of intellectual ferment. Therefore,the number of biomedical scientists has dramatically increasedrelative to the number of other workers."

This raises some questions for the NIH and others who supportscientific research. "Should we be supporting the trainingof so many new scientists? My own feeling is that these numbersare largely generated by academic institutions who bring in largenumbers of graduate students who help the faculty do their work."

Dr. Varmus does not want to cut back on the support of the "trulyoutstanding," but thinks people who enter this field shouldbe aware of its difficulties. "Not everyone who goes intobiomedical research can expect to have an independent laboratoryat Harvard," he said.

Alternative Careers

He pointed out that a great many interesting alternative careersin biomedical research have been generated in industry, law, andbusiness, and he encouraged science graduates to be aware of suchopportunities outside the academic laboratories.

Researchers are not the only ones the NIH hears from in regardto how to spend their money. Congress earmarks some of the funds,and advocacy groups also appeal directly to the Institutes.

Dr. Varmus said he did not like the reasoning behind some of theappeals, which are "based on body counts." These groupsadvocate that research dollars be based on the number of deathsfrom a disease. Advocates, he said would be better off stressingthe cohesion of medical problems rather than the divisions.

Dr. Varmus also thinks that the NIH needs more champions to helpbolster its appropriations and reputation. "We don't haveunlimited advocacy. Despite all the work we do, the name NIH isnot as familiar as NASA or some others. There is a fairly substantialamount of negative thinking about science at the moment, as wellas ignorance of how it works."

In this regard, he also criticized the pharmaceutical industryfor taking credit for developing drugs that in reality stemmedfrom the basic research of NIH-funded investigators. "Itleads to a misunderstanding of how science works and hampers ourefforts to persuade Congress that if they want new drugs, theyhave to support basic research," Dr. Varmus commented.

Just as nonscientists must understand how science works, scientistsmust develop an appreciation for how government works, namelyhow the NIH gets funded, Dr. Varmus said, and must act as advocatesfor the NIH, especially when federal funds for research are threatened."The loss of large amounts of money in my view," hesaid, "will have a devastating effect on our ability to functionas a research organization."