Pausing NIH study sections is going to be fine
In fact, it's a good thing. The NIH needs reform.
Panic unfolded yesterday as the NIH announced a pause in study sections. Study sections are groups of mediocre scientists who decide which grants are funded. You may bristle at my word choice of ‘mediocre’ but data support that claim. Here is research by Ioannidis in Nature:
He looked at authors of papers with more than 1000 citations. These are highly influential studies. I have published 530+ papers, but only one of mine fits this bucket. As such, I would make this group, but I would not have 2 years ago.
He compares this to study sections members and you can see the poor overlap. Ioannidis conclusion: conform and be funded. NIH seeks mediocre ideas that tread along established lines and not highly novel views. It does a bad job of funding people who do truly transformational work.
Trump has paused study sections to allow future NIH director Jay Bhattacharya to revisit the priorities. This is completely normal and reasonable. Jay might decide to run a randomized trial testing the current study section structure against proposed alternatives, such as the modified lottery, and other ideas.
If you randomized grant giving to several strategies, and follow the portfolio of funded projects 5 or 10 years into the future, you could analyze measures of citation, publication, impact, patent and other downstream proxies. If, there are no differences between the current process, and less bureaucratic processes, you should choose the method that has the least overhead price. This might be something Jay explores.
Alternatively, Jay might decide that having NIH funding for things like CT screening for homeless people is a misplaced used to priorities. There are many examples of woke science funding that will not survive in a Trump administration.
Scientists who quit X may protest but we live in a democracy. If you prefer more funding for diversity supplements, try to win the next election. For the time being, prepare for cuts in diversity supplements.
Interestingly, the one type of diversity that NIH is not interested in funding is intellectual diversity. That's probably a reason why they've had so much stagnation on intractable problems such as cancer and neurological conditions. They went all in brute force sequencing of tumors, and the amyloid hypothesis, for e.g.
Some people say that if the pause, which is completely reasonable, continues, people will lose their jobs in research. Of course this is true. I suspect the pause will not continue for a great period of time, but, at the same time, some people in research need to lose their jobs.
The government cannot be a welfare program for everybody doing low quality, low credibility, irreproducible, low value of information research. It has to use public dollars in a wise way. That has absolutely not occurred in the past. A pause is necessary to tackle this intractable problem.
In many ways, Jay is the perfect person to tackle this problem. He's not a laboratory scientist. He's an economist. The difference between laboratory scientists and economist is that the latter are much better at thinking brutally and clearly about the trade-offs and expected payoffs of research. Jay has already been on record as saying he thinks the NIH is not willing to push the envelope. It doesn't fund truly transformative work. I completely agree with him. And he should direct funding in that way.
The NIH call some of its pathways early innovation or something similar, but typically this is derivative work as well. The NIH does not actually take risks on truly different ideas. The envelope is not being pushed.
And the American people that want the envelope pushed. They don't want continued marginal drugs. They want new ideas. We have made no progress in Alzheimer's disease in part because of the NIH's dogmatism. I look forward to a renewed focus on a diversity of ideas in science research.
Finally, if academics want to take a sky is falling approach to every single thing Donald Trump does, they're only going to exhaust themselves.
I’m thrilled. This administration is putting common sense back in to governance. In a sense these moves also restore basic ethics. By ignoring equipoise, the NIH has been funding a whole slate of garbage that has not resulted in the betterment of our patient’s lives. Parkinson’s and Alzheimer’s treatments have made virtually no progress. This misallocation of funding was done all under the guise of radical compassion. I used to think this travesty happened because of ignorance, but what was revealed over the pandemic was a truly evil face. Much of it was purposeful.
It is easy to see why our healthcare expenditure has nearly doubled in the last 14 years while life expectancy has decreased for the first time since the industrial revolution.
We owe a lot to our heroes, Battacharya, Prasad,Kheriaty, Makary, Atlas, Kuldorff, and others in the US and Jefferson and Henegan in the UK.
I did not expect the correction to happen all at once, but perhaps it will. What a blessing if so.
The process of funding research has become more and more political, and with that politics, the winners are those with influence, not those with good ideas.
In fact, good ideas would be completely unwelcome in the current structure. It’s Thomas Kuhn, the custodians of all the old paradigms.
Profitable sacred cows that are clearly wrong but profitable continue getting funding:
1. Mutation theory of cancer.
2. Cholesterol theory of cardiovascular disease.
3. Stents, the view of vascularity as mere plumbing.
4. Blood pressure, requires everyone be on drugs.
5. High stomach acid theory of GERD.
6. Amyloid plaque theory of dementia.
There are many many more. All the above theories get tons of funding because they sell drugs. The people selling drugs (and medical devices) are running EVERYTHING in the political realm of NIH. Everything.
Meanwhile anyone with truly innovative ideas would hardly survive a moment there.