The real “return” on research investments is in clinical benefits, diagnostics, therapeutics, and preventive measures. The lead time on those is often measured in years, so they can be hard to directly correlate to investments.

Question: How much is the NIH's funding process affected by politics?

Francis Collins: We’re fortunate at NIH, that the Congress has in general has adopted a view that making priority decisions about scientific research is best done by scientists.  People talk about areas in other parts of the government where there’s earmarking or sometimes in a less friendly way called "pork" funding; we are relatively free of that.  Congress will certainly indicate to us when they think there is an area that needs more attention, but rarely will they attach a specific dollar figure to that.  They’ll just ask us to look at that a little more carefully.  So we have a very good working relationship.  

Likewise with the administration.  The administration is interested in seeing NIH be very productive and they want to hear all the time about how we’re spending our money and have us defend why it’s the right way to go.  But they’re generally reluctant to say, “Well you should spend X dollars on Y disease.”  And that just doesn’t seem like the way to make the choices.

Question: How much say should the public have about what federal research money is spent on?

Francis Collins: Well the public does have a lot of say.  We have many disease advocacy groups who are constantly putting forward their case for why more research needs to be done on their condition, and of course, I would love to meet all of those requests, but we are often stuck in a situation where we’re limited in resources, and so we can’t do everything.  

But certainly we work I think pretty effectively with a lot of those groups to identify where are the areas that are most ripe for investment.  And sometimes that means coming up with an RFA because something is about to break.  Sometimes it’s organizing a workshop and trying to survey the field of a disease that seems to have gotten stuck for a while and figure out how to get it unstuck, and figure out how to get some new ideas and new scientific minds working on the problem.  I would say, for the most part, we have very productive, synergistic, friendly relationships with disease advocates who understand how the process works, are anxious to see resources put into their disease, but want it to be done in a fashion that’s scientifically productive and not just throwing money at the problem.

Question: Are there areas of medicine or technologies where research dollars go farther?

Francis Collins: Return on investment is always an interesting question when it comes to medical research.  Well, what would you call "return?"  Is it that you’ve published a certain number of papers?  Well, that is one metric I suppose and that they are in high-impact journals, that’s another metric.  But really what we’re about is trying to help people.  

So the real return you’re looking for is clinical benefits, diagnostics, therapeutics, preventive measures.  The lead time on those is often measured in years.  And so it maybe quite difficult to assess when you’re just looking at a program that’s been underway for three or four years, how does it measure up in terms of what you’re getting for your dollars compared to some other program that similarly is sort of in an early stage of moving into clinical benefits?  But we try to do that to the extent we can and I think we should.  This is taxpayers' money; the taxpayers believe in us as the place that is gonna make that next breakthrough.  They want to be assured that we’re using those dollars in the most effective way possible.  Sometimes people think NIH is just, you know, playing around in the lab.  I can assure that’s not the view of people here, but we need to be prepared at any moment to defend the choices we’ve made as having had the best chance of benefiting real people out there who are counting on us to use their money wisely.  It is their money.

Recorded September 13, 2010
Interviewed by David Hirschman