Bhaven Sampat

For most American biomedical scientists, the NIH is the major source of funding for their research projects. For economist Bhaven Sampat, Ph.D., assistant professor of health policy and management in the Mailman School of Public Health, the NIH is his research project. With recent funding from a Robert Wood Johnson Foundation Investigator Award in Health Policy Research, Dr. Sampat is studying how the NIH makes decisions about where and how to allocate its funds. InVivo spoke with Dr. Sampat about why he thinks it is so critical to understand the NIH’s funding patterns and what those patterns mean for today’s researchers.

Why study the NIH?
The NIH enjoys broad political support based, in part, on the belief that its allocation choices drive advances in medicine and improve health. But surprisingly little academic research has shown the impact of NIH funding on this country’s health related goals and the responsiveness of its funding patterns to health priorities. With a $30 billion budget, the NIH is the single largest funder of biomedical research in the world. It is important to know how it makes decisions, the extent to which its mission to “extend healthy life and reduce the burdens of illness and disability” is actually being achieved, and if and how the process might be improved.

Your study is titled ’The Political Economy of the National Institutes of Health.’ What do you mean by a ”political economy?”
The “economics” part refers to the study of the allocation of scarce resources. The word “political” is there because politics, not the market, plays a major role in how monies for research are disseminated. Congress, the scientific community, interest groups that represent specific diseases, and the media all have significant influence.

What is already known about the allocation process?
At the beginning of every fiscal year, with input from the scientific community, each NIH institute prepares its budget and consults with the U.S. President’s budget office. Once the president signs off on the NIH budget and submits it to Congress, that’s where the action starts.
      Often at this stage lobbyists who represent interest groups attempt to obtain funds for their specific diseases. They gain media attention by bringing celebrities to Capitol Hill to testify on behalf of certain diseases. Sometimes these efforts result in disease-specific “earmarks” mandated by Congress, which are controversial because of the concern that these political choices may crowd out peer-reviewed research.
      One of the things I will study is how the strength of disease advocacy groups – including the extent to which they lobby – affects overall disease specific funding patterns, through earmarks or other channels. From a policy perspective, allocating funds as a result of the strength of disease groups may be seen as problematic, because some diseases may just be less sexy or politically correct than others and therefore less attention is drawn to them. Urinary incontinence, for example, probably has more of a stigma associated with it than some other diseases. It has been difficult to rally attention for pancreatic cancer because there isn’t a large survivor community. In a world of scarce resources – where more money for one disease means less for another – I’m not sure the best way to fund research would be based on how well a particular disease group can organize, lobby, and capture media attention.
       We have not really had an informed national debate on these issues, and I think part of the reason is that we haven’t had data or evidence on how the allocation process currently works. I’m hoping my work can help set the stage for a discussion about the NIH grounded in facts and data, rather than anecdotes.

Why should we care about how the NIH makes its decisions?
Not knowing how these decisions are made presents a major obstacle to policy discussions. If we want better health, then as a society we need to ask ourselves how much money should be allocated via Congressional earmarks versus the opinion of the scientific community. How much should be spent on clinical research versus basic research? How much influence do we want disease interest groups to have and to what degree do we want to insulate allocation decisions from political influence? Should the NIH simply fund the best science, or should it target specific diseases?
      Down the line, the data might help us answer the big questions, such as: “What is the rate of return on NIH funding?” and, “Have research results justified the amount invested in research?” These are tricky and sometimes controversial questions, but I think all of us should be interested in the answers.