5 Questions: Pizzo on NIH funding

President Barack Obama signed Feb. 17 an economic stimulus package that includes $10 billion for the National Institutes of Health. Philip Pizzo, MD, dean of the medical school, spoke with staff writer Michelle L. Brandt about how these new funds could affect medical research.

1. What were your initial thoughts on the large dollar amount being attached to NIH in the stimulus package?

Pizzo: This is terrific news, and we must acknowledge the support of Sens. Arlen Specter, R.-Penn., and Tom Harkin, D.-Iowa, and Reps. Nancy Pelosi, D.-Calif., David Obey, D-Wisc., and Anna Eshoo, D.-Calif. Sadly the NIH budget has been flat for nearly six years, and the purchasing power of NIH dollars is now at least 13 percent less than it was in 2003. There is a backlog of highly meritorious NIH proposals that would benefit from funding as well as large national efforts (like the Clinical and Translational Science Awards, or CTSAs) that have been underfunded. There are also critical needs for equipment, facilities, infrastructure and support for students, postdoctoral trainees and investigators - especially young investigators.

2. You've said many times that it's important for NIH funding to be 'sustainable and predictable.' Would your preference be for a steady increase in funding over the next several years, versus this one-time infusion?
It is reassuring to note that the Obama administration recognizes the importance of science and technology and that Congress appreciates the fact that the NIH is the single agency that has made the USA the leader in biomedical research and related breakthroughs. Many of the advances in modern medicine are the result of investments made over the past six decades by the NIH in biomedical research.

Pizzo: While an immediate bolus can help with infrastructure, equipment, facilities renovation and support for unfunded but highly meritorious projects, it is clearly important to sustain the investment in science. Stops and starts have extremely negative effects on the training pipeline, the success of new investigators and the ability to pose and pursue bold and innovative ideas. Thus sustainable funding with some degree of predictability is critically important. That will be the only way we can truly optimize our returns on long-term investment in science.

3. Are there particular projects that had previously been put on hold due to lack of funding?

Pizzo: There are surely meritorious RO1 grants (which are initiated by investigators) that were approved and not funded and that could now be supported with stimulus funds. And the stimulus funds also include replenishments to cutbacks that have had a big impact, such as those that occurred with the CTSA grants. The last round of CTSA awards were underfunded by nearly half of the approved budget dollar award. That was because of shortfalls in the NIH budget. These awards are key to advancing clinical research, and this is one area where the payoff can be significant now. It is an example of 'shovel-ready research.'

4. It's great that this money is becoming available, but are we seeing cuts in other funding sources?

Pizzo: It is true that sponsored grants from the NIH are one of many sources of funding. Not-for-profit foundations have been impacted by the economic downturn and are able to fund fewer projects. This is a problem since foundations generally provided seed grants for younger investigators or new areas of research that would prepare them for federal support in the future. The lack of this pump priming could be a problem that could be addressed by having the NIH emphasize funding of new investigators, but this too would require balance.

When all is said and done, however, the NIH is the key and largest source of biomedical research funding. Its impact is more significant that other funding sources. The major non-profit funder of biosciences is the Howard Hughes Medical Institute, and while their portfolio has also been impacted, they remain a large contributor as well.

5. Some critics of the package still argue that money for research is not an effective way to stimulate the economy in the short term. Is there any evidence that investing in medical research creates jobs?

Pizzo: Research funding has an immediate effect on jobs. New grant awards require and support the hiring of additional people. By contrast, when grants are not funded, staff (and trainees) are laid off. There is also a downstream impact. When more grants are funded, more supplies and reagents are required and ordered from vendors around the country. This impacts jobs. Further, when more research is funded, more local consumables are required, whether it be housing or other community services. In addition, increased research activity often requires infrastructure enhancements such as renovation of existing facilities and construction of new ones. Over the longer term, the greater the NIH money, the more progress we are likely to see from basic research to commercial applications. Not supporting that pipeline now will have dire consequences in the years ahead.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

Leading in Precision Health

Stanford Medicine is leading the biomedical revolution in precision health, defining and developing the next generation of care that is proactive, predictive and precise. 

A Legacy of Innovation

Stanford Medicine's unrivaled atmosphere of breakthrough thinking and interdisciplinary collaboration has fueled a long history of achievements.