NIH tries to balance scientists' interests with taxpayer interests

Washington is well schooled in conflicts of interest involving money, but a recent congressional hearing on the National Institutes of Health exposed a different kind of conflict, one that pits taxpayer-funded scientists' interest in making discoveries against the taxpayers' desire for near-term therapies and ethical restraints on research.

These nonmonetary conflicts of interest surfaced during a January 22 Senate hearing into recent revelations that NIH officials and outside companies have struck roughly 1,500 financial deals over the past five years. NIH officials testified that they recruit top-flight scientists by offering them a compensation package with pay rates that can reach $200,000 a year, the right to make financial deals with outside companies, and the freedom to use the institutes' well-fitted laboratories to pursue their own discoveries.

This freedom to pursue long-term research is an intangible but very real incentive for scientists, said NIH Director Elias Zerhouni after the hearing. He characterized it as a necessary means of attracting scientists who might otherwise choose to remain at commercial and university-based research centers. "Recruiting to NIH is one of the hardest things I've done," he added. Other scientists at the hearing, including Stephen Katz, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, echoed Zerhouni's statement about the need to offer the opportunity to make discoveries. This intangible, nonmonetary benefit "is really important to understand," Katz said. "It does get to the crux of what passion the NIH scientists have."

This passion to explore has two elements. One is the desire to discover biomedical patterns that can eventually lead to medical therapies. Scientists "have a passion to see what they are doing to benefit mankind," Katz said. Taxpayers want those benefits, and so do the legislators who appropriated $28 billion for NIH in fiscal 2004.

The other part of the passion is the desire to make discoveries that win peer recognition. "The strongest motivation for scientists is being respected by leaders" in science, said Bruce Alberts in an interview with National Journal last year. Alberts is a biochemist and the president of the National Academy of Sciences, a private organization of U.S. and foreign scientists, entrepreneurs, and policy advocates. "We care a lot about how other scientists think about us, and we don't care a lot about others who are not scientists." This intangible, nonmonetary recognition can earn scientists very tangible benefits: new NIH grants, new jobs, prizes.

NIH witnesses at the January 22, 2004 hearing also cited the importance of having the respect of fellow scientists. "Psychologically, it will make many an NIH scientist feel [like] second-class citizens to some of their academic colleagues" if corporate deals were banned, said one. "It would not be a favorable decision," said another, who also warned that scientists might leave NIH if they didn't have the same opportunities as private-sector scientists.

But the passion for discovery can create a conflict of interest with taxpayers, because some taxpayers want more short-term gains in medical therapies, preferably treatments that come with a minimum of ethical controversy. It's this taxpayer preference for health care therapies that prompts politicians to complain about NIH's focus on science at the expense of health care. For example, at an October 2 hearing, Sen. Hillary Rodham Clinton, D-N.Y., asked Zerhouni to undertake more comparisons of medical therapies, but Zerhouni responded that NIH didn't have the money for such extra work. The issue came up again at the January 22 hearing, when Sen. Tom Harkin, D-Iowa, the subcommittee's ranking Democrat, said he wanted NIH's science converted into advances in health care. "It is not the National Institutes of Basic Research. It is the National Institutes of Health," he said.

NIH's mission is "increasing knowledge," Zerhouni said at a September 30 press conference to publicize a draft plan to reform NIH spending. Scientists contend that their focus on basic research will yield enormous health care benefits in the long run.

In promoting the reform plan, Zerhouni has complained that scientists at each of NIH's 27 institutes and centers are reluctant to pool their funding. If Congress gave him the authority to force such collaboration, Zerhouni said, he could accelerate the availability of the therapies desired by taxpayers.

Scientists' passion for discovery also generates ethical controversies. The most prominent debate concerns NIH research into stem cells taken from human embryos. In August 2001, President Bush decided that NIH could use only existing lines of embryo stem cells for this research, but NIH officials continue to emphasize embryo-cell research, rather than research on the noncontroversial stem cells taken from adults.

Conflicts between scientists' priorities and the public's wishes would be very difficult to track, said subcommittee staffers. If Congress tried to restrict the scientists, "they might all leave," one said. The staffers said the subcommittee has not looked at such conflicts.

Throughout the hearing, Zerhouni declined to say that he would end the deal-making, but he announced the formation of a 90-day advisory panel to be co-chaired by Alberts and Norman Augustine, a former Pentagon official.