Communication with the public key to scientific advancement

June 2007

When Elias Zerhouni, MD, became director of the NIH in 2002, only 6% of the country knew that the government agency had played a role in the health care progress of the past 30 years.

Five years later that number has risen to 12%, but Zerhouni said only one-third of the country is aware of the NIH.

“We have to do a better job of communicating the benefits of investing in the NIH to the public,” Zerhouni said at the American Society of Hematology 48th Annual Meeting and Exposition, held recently in Orlando.

Zerhouni spoke with Colin Blakemore, Fmed Sci, CEO of the Medical Research Council, the British equivalent to the NIH, albeit with a fraction of the budget ($1 billion annually vs. $28 billion annually).

Blakemore said the success of any public scientific venture depends on communication with the public about the benefits and risks.

“For example, the British attitude toward stem cell research is quite different than what is seen from your government in the United States,” Blakemore said. “However, the consensus is not something that emerged suddenly; it is the result of extensive public debate that began almost 25 years ago with the first in vitro fertilization.”

Although Blakemore cited stem cell research as a communication success story in Britain, he said there are other examples where the government was less successful.

Animal research

When the Animal Liberation Front was formed in the mid-1980s to target fox hunting and soon expanded to combat animal research, academic researchers assumed that the group was ill-prepared, ill-coordinated and they would simply disappear if ignored.

Blakemore said that proved to be a miscalculation.

“That approach created not only increasing confidence among the extremists, but also confusion among the public because our silence made the public believe we had something to hide,” Blakemore said.

As violence and extremism accelerated in the 1980s and 1990s, it eventually got the attention of the British government. In 1997 the New Labor party announced a high level investigation that would review the justification for animal experiments.

“The government may not admit this except in quiet, off-the-record moments, but that decision probably contributed to the further rise in extremist violence,” Blakemore said.

Blakemore said public opinion has begun to shift in the last few years as scientists have become aware of the unique challenges in communicating with the public and have been more willing to do so.

“The public does not judge risk in terms of hard evidence and statistics. They judge risk in terms of personal factors and judgments, especially the role of personal benefit,” Blakemore said.

Scientists have made a greater effort to become visible, and Blakemore said that has contributed to trust as well.

Increased capacity

Researchers in the United States have not had to deal with an equivalent extremist threat, but Zerhouni agreed that communication is important as the NIH struggles to define its importance for the broader public.

“Part of the perfect storm is the doubling effect, where those in Washington believe they have already done their share after doubling the NIH budget from $14 billion to $28 billion and they are saying ‘what are we getting for it and why should we do more?’” Zerhouni said.

Although Zerhouni said the current political environment plays a role in the NIH funding problems, one of the major drivers is one outside of Washington, D.C., that ironically might be considered positive.

“The real driver of our funding problem is an enormous increase in capacity, which is positive,” Zerhouni said. “When I was a dean, we measured success by the number of cranes building new facilities on our campuses. If you were not successful, you were a one-crane dean, and if you were very successful you were a five-crane dean.”

Between 1990 and 1997, medical colleges in the United States spent $3.2 billion on new research facilities. From 1998 to 2007 that amount increased to $14.9 billion.

In 1998, the NIH received 24,151 applications and had a success rate, defined as acceptance, of 31%. By 2006, the number of applications had increased to 33,119 and the success rate had dropped to 20%.

Addressing myths

Zerhouni said research institutions built these new facilities during the doubling and are now finding it a challenge to obtain grants.

“The demand for grants took off just as the NIH budget was landing. Some colleagues say it was a crash landing and I’m sympathetic to that point of view,” Zerhouni said.

Zerhouni said the funding restrictions have led to a number of myths about how the NIH allocates money, which he sought to address during his presentation.

Some believe the NIH overemphasizes applied research at the expense of basic research because it must justify its funding to Congress. However, Zerhouni said basic research was about 54% of the NIH budget in 1998 and is 56% today.

In a typical year, the NIH spends about 60% of its budget on basic research, 25% on translational research and 15% on clinical research. In the private sector, where the amount of money spent is $59 billion rather than $28 billion, the numbers are reversed with 60% spent on clinical research.

“The engine of discovery is the NIH. We can take long-term risks that private companies cannot take and we will continue to do that,” Zerhouni said.

A second myth is that the NIH has spent more on solicited grants than unsolicited grants. Zerhouni said that about 90% of the NIH budget goes for unsolicited grants.

“There is some truth to the fact that we have spent more on solicited grants, but that is because our budget has doubled,” Zerhouni said.

A third myth is that the NIH Critical Path Initiative has drawn funds from other important areas. Zerhouni said this accounts for only 1.2% of the overall NIH budget.

“The core mission of the NIH is to continue our effort at discovery and generating our efforts at new knowledge,” Zerhouni said. “We are still far away in science from being as effective as we could be, and we need to continue our efforts at fundamental discovery.”

For more information:

• Blakemore C, Zerhouni E. Challenges in government funding for research. Presented at: 48th Annual Meeting of the American Society of Hematology; Dec. 9-12, 2006; Orlando, Fla.