Beggars should be choosers

When digging in against cuts to the National Institute of Health budget, Duke should be careful where it turns for support.

The University has done well to prepare for the inevitable. Right now, the NIH faces a potential 5 percent reduction in its budget in the coming year. More than 80 percent of the NIH’s $30 billion budget is invested through research grants, and Duke gets a big slice of that pie: Almost 25 percent of external funding at Duke’s schools comes straight from the NIH. A reduction in the NIH budget will impact all institutions receiving funding, including Duke’s School of Medicine, the Nicholas School of the Environment and the Pratt School of Engineering.

Duke has put a couple of solutions on the table. The School of Medicine has adopted an internal bridge funding plan that uses indirect dollars researchers receive in grants to fund projects that have been unsuccessful in receiving NIH funding. So far, this scheme has been able to support 50 percent of applications.

Bridge funding is neither a new solution—it has been around for years—nor is it a sustainable one. The amount of money available for bridge funding depends on the amount of money brought in by external grants. This is fine when the total amount of grant money brought in stays level from year to year. But when the overall amount of grant money drops overall, as it would following the NIH cuts, the bridge fund behaves like a Ponzi scheme trying to pay off its investors: A drop in total grants received will result in more demands on the bridge fund at the same time its source of income falls off. This will not work forever, especially if annual cuts to the NIH budget become the new normal.

This leaves us with one other option proposed by Duke in the face of cuts: to increase the amount of partnerships between researchers and non-federal corporations. This also is not new. Many Duke officials already receive payments from corporate sources. For example, Victor Dzau, chancellor for health affairs and president and CEO of the Duke University Health System, receives more than $600,000 from his membership on the boards of PepsiCo, Medtronic Inc. and Alnylam Pharmaceuticals.

Corporate partnerships might be a necessity—both for the funds and services they provide—but they are a dangerous one. Obviously, partnerships in medicine generate conflicts of interests. A 2012 article by The New York Times reported that doctors receiving funding from drug companies were often more likely to prescribe drugs differently and in a more risky manner—most notably through the prescription of strong antipsychotics to young children. But corporate partnerships also undermine the perceived legitimacy of a research institution; lay people may not be able to evaluate research on its scientific merits, but they can tell whose hands are in whose pockets.

There are hard, but possible, alternatives. In January, the NIH decreased the salary cap on NIH grant funds by $20,00, which means that salary expenses previously billed to the NIH now must be picked up by the University. Some researchers do not make much, but top researchers can pull in salaries more than $300,000 a year. Researchers themselves should be willing to eat an ultimately inconsequential salary decreases in the name of science.

Continuing our scientific research in down times is crucial. But when we do so at the cost of our credibility, we only undermine ourselves.