uppose you needed to have a CT scan for a sudden, severe headache and partial loss of vision and your doctor asked a nutritionist to read it, rather than a radiologist. Would you trust the diagnosis? Evaluation by a different — and what most would consider a lesser — standard is essentially how a significant amount of research funding is approved by one component of the National Institutes of Health.
Let me step back for a minute before plunging ahead. Federally funded scientific research runs the gamut from studies of basic physical and biological processes to the development of applications to meet immediate needs, such as the development of a universal flu vaccine or clinical trials for Alzheimer’s disease. Government funding is especially essential for providing the scientific knowledge that underlies new medical treatments. The NIH, the nation’s major funder of nonmilitary research, has generally been a reliable supporter of high-quality research, conducted at its Bethesda, Md., campus and at universities and research institutes across the U.S.
Much of the substantial NIH budget, currently about $35 billion, goes to fund grant proposals from researchers across the country. Judgments about the merit of these proposals are made by discipline, correlating with the NIH’s 27 institutes and centers — cancer, aging, vision, heart disease, nursing, and so on.
But there is a glaring, systematic exception, and it resembles the example above. One branch of the NIH is far less equal — in the sense of both scientific rigor and importance — than the others: the National Center for Complementary and Integrative Health (formerly the National Center for Complementary and Alternative Medicine). The brainchild primarily of then-Sen. Tom Harkin (D-Iowa), who held views of health and medicine that were unconventional (to be charitable), this center is the dirty little secret of the research community and Congress.
The mission of the National Center for Complementary and Integrative Health is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.” But complementary and integrative health — which is sometimes referred to as alternative medicine — often means implausible and unworthy.
Peer review of grant proposals submitted to the National Center for Complementary and Integrative Health is performed by practitioners or promoters of alternative medicine, not by experts in in the disease or condition under investigation. This makes possible the funding of projects that are trivial or poorly designed. Many of the interventions have proven to be worthless. For example, a study supported by the center found that cranberry juice cocktail was no better than placebo at preventing recurring urinary tract infections — even though at the time the center’s own website listed the results of many studies showing that cranberry juice is of limited value for urinary tract infections.
Other supported studies include “Long-Term Chamomile Therapy of Generalized Anxiety Disorder,” “Mindfulness Training to Improve ART Adherence and Reduce Risk Behavior Among Persons Living with HIV,” and “Restorative Yoga for Therapy of the Metabolic Syndrome.” This is what happens when the inmates run the asylum.
Grant proposals for complementary and integrative health studies could be evaluated more effectively by other NIH institutes or centers, such as the National Institute of Neurological Diseases and Stroke, the National Institute of Mental Health, or the National Heart, Lung, and Blood Institute, where they would receive more rigorous and impartial peer review.
In 2016, the NIH was able to fund fewer than 20 percent of the investigator-initiated research grant proposals it received. The fact that the National Center for Complementary and Integrative Health was allowed to spend $130 million in fiscal year 2016 is an affront to the NIH-funded researchers (and aspirants) who are at the cutting edge of their disciplines but face increasing difficulty getting federal funding for studies that rank high on scientific merit.
The National Center for Complementary and Integrative Health isn’t the only NIH set-aside, a term that means funds must be spent for a certain purpose or discipline. Another boondoggle, started almost three decades ago as part of the NIH’s Human Genome Project, set aside a portion of the project’s budget to establish the Ethical, Legal, and Social Implications (ELSI) Research Program. It has created a kind of cottage industry — paid for by more than $335 million in grants over its lifetime — among ethicists, sociologists, and others at the fringes of the research establishment whose work wouldn’t have had a prayer for funding if it had to compete with mainstream scientific disciplines. Much of their output has focused on the need for excessive, unscientific regulation of important research or clinical applications.
The prodigious benefits of basic research won’t come from spending on the kinds of projects favored by the NCCIH and ELSI. International research and development is highly competitive. The Paris-based Organization for Economic Cooperation and Development has projected that China will overtake the United States in research and development spending by around 2019.
To prevent America’s scientists and businesses from becoming also-rans in the kinds of technological innovation that keep the U.S. economy competitive — in fields ranging from biomedicine, materials science, and chemistry to robotics and nuclear engineering — we need to increase overall spending. But we also need to be more discerning about our research priorities, which will require the scientific community and politicians to condemn the funding of projects simply because they are politically correct or a sop to lesser disciplines.
Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University’s Hoover Institution. He was the founding director of the FDA’s Office of Biotechnology. He has never applied for or received an NIH grant.