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Former NIH director: The sequester will set back medical science for a generation

Dr. Elias Zerhouni led the National Institutes of Health (NIH) from 2002 to 2008. A radiologist and biomedical engineer, he has served as a faculty member in both areas at Johns Hopkins University, and currently works as director of research and development at Sanofi, a French pharmaceutical firm. He spoke to me on the phone this afternoon from his office in Paris; a lightly edited transcript follows.

Dylan Matthews: The NIH is facing an 8.2 percent across-the-board cut in future years (5.3 percent for 2013). What would that do to the institutes, were it to take effect?

Elias Zerhouni: I think the suddenness of it and the depth of it would be a disaster for research, which is not an activity that you can turn on and off from year to year. It’s an activity that takes time. The most impacted are the young, new investigator scientists, who are coming into science, and will now abandon the field of science. There will be a generational gap created.

An average grant is five  years long, because science is like that. So think: That means that every one year, only 20 percent of the grants come to their end. So any one year, NIH only has 20 percent of its money available for new grants. At NIH, about half of the grants get terminated at five years, but the rest get to be continued, as you don’t want to throw away good research. So the half of it that's left has to go to very promising areas of science, and you have 10  percent left.

If you take 8 percent of that 10 percent, it’s going to come from new science, new people, young investigators; we are going to maim our innovation capabilities if you do these abrupt deep cuts at NIH. It will impact science for generations to come.

Do you think the number of grants would shrink or would they just be worth less?

The latter. That’s what I’m sure NIH would do. That’s what I did. You eliminate the inflation increase, you cut every grant 2-3 percent. You do a lot of things, but it’s really hard to cover 8 percent at once. And I’ve seen it happen when I had no increase. This was 2006, after Katrina, our budget was kept flat for two years. And it was hard then to balance the books and make sure that we didn’t damage the prospects of science, and the prospects of medicine.

I don’t want to sound dramatic, but it’s not theoretical. People have crocodile tears for all the various types of cuts, but this kind of cut is damaging. It’s not something that you can manage year to year. It’s an investment. They cannot go up and down with the political winds.

I think people have a sense that NIH is just developing drugs, but that's not most of what they do, right?

 Right. NIH funds, 55-60 percent is for basic science, to understand biology. We got 138 Nobel Prizes, five worked directly at NIH and all the others had funding. The product of NIH is knowledge, and 55-60 percent of the budget goes to that.

The second area is vibrant human capital, which is the part that I’m most concerned about. If we don’t offer the young bright minds a career that is predictable, then we lose them. We have, like, 17,000 scholarships that we give to people to stay in science.

Then 25 percent of the funding is translational sciences, where we try to understand disease, or the impact of a treatment. One was to prove or disprove whether hormone therapy is good for women. It cost a lot but we needed to know, so we did it. There’s a public health, translational commitment.

And then the rest is operational, maintaining cancer research centers, and so forth. So 40 percent is what you’d call applied research. Most of what we call product research, true translational research, is done by industry. The NIH budget is $30 billion, and the industry spends $60 billion making drugs. NIH does not want to be the one making the drugs.

That answers one possible defense of the cuts, which is that the scientists could just go work for private industry instead.

That’s ridiculous. That’s the most ridiculous, caveman statement I’ve ever heard. That’s not the way science works. Science works with bright young people who are attracted to science. David Baltimore had the Nobel prize at 35 for a discovery at 27. Today he wouldn’t even get a grant from NIH. The average age for grant recipients is 38 or 39. Research is an investment, it’s not an expense.