National Institutes of Health (NIH) Director Francis Collins, M.D., Ph.D., April 7 appeared before the Senate Labor-Health and Human Services, Education, and Related Agencies (Labor-HHS) Appropriations Subcommittee to discuss the agency’s fiscal year (FY) 2017 budget request.
Subcommittee Chair Roy Blunt (R-Mo.) began by criticizing the administration’s request to reduce discretionary funding for the NIH by $1 billion. “I certainly would not think that is the way we would want to follow our effort last year to increase research by $2 billion,” he said, adding that last year’s increase should not be a one-time investment and that it is time for a long-term commitment to medical research.
Responding to a question from Chairman Blunt about what would happen if the NIH budget is cut as proposed by the administration, Dr. Collins answered, “Losing $1 billion for medical research at the present time would be devastating. We would have to cut the number of new and competing grants that we give by a very substantial number. Great ideas that scientists are putting forward would go unsupported. Momentum that has been started thanks to your efforts in FY 2016 would be severely damaged.”
Dr. Collins thanked the subcommittee for the $2 billion increase in the NIH’s budget in FY 2016, saying, “That investment so energized our community and came at an unprecedented time of scientific opportunity.” Acknowledging this might be his last opportunity to appear before the subcommittee, Dr. Collins made what he called “some bold predictions” in ten areas where he believed NIH could make major advances in the next ten years given a sustained commitment of resources.
Asked by Senator Barbara Mikulski (D-Md.), the ranking Democrat on the full committee, what amount was needed, Dr. Collins replied “inflation plus 5 percent.”
Senator Lamar Alexander (R-Tenn.), who as chair of the Senate HELP Committee, is working with Democrats to create an “NIH Innovation fund,” asked if the five funding priorities he has identified for such a fund, which include Precision Medicine and the cancer “moonshot,” could be accomplished without funding “cliffs.” He also asked what type of oversight would be needed in terms of a strategic plan in each of these areas.
Dr. Collins replied, “We do believe that for each of those five areas we could, in the space of a few years, identify components that could be nicely supported through this mechanism and would not result in a cliff.” He added that given “appropriate flexibility,” NIH could put together timetables and budgets and would be happy to submit work plans and then be held accountable.
Regarding efforts to encourage young researchers, Collins noted that one of the ways to attract more physicians into science is NIH’s loan repayment program. He praised a recent proposal by the authorizing committee to increase the cap on the program to $50,000, which he said “will improve our opportunity to recruit those much needed researchers into our workforce.” [see Washington Highlights, Feb. 12]
Senator Dick Durbin (D-Ill.) asked Dr. Collins if he would consider using NIH’s statutory authority under the Bayh-Dole Act to exercise “march-in” rights to protect consumers from overpricing by pharmaceutical companies. Dr. Collins said he shared the concern about the impact of cost on access to drugs, but was “not sure that NIH is in a great position here in terms of the levers that need to be pulled” to do something about drug pricing He went on to say that the Bayh-Dole Act appears to be intended more to address circumstances where the product is not available because it was not being commercialized. He said that NIH is looking at these situations on a case-by-case basis, but he is concerned about the potential loss of interest in industry participation if NIH begins to use March-in “in a very broad way” to address drug pricing.
Senator Durbin said that applying Bayh-Dole to even one case sends a message to pharmaceutical companies that patients need to have access to drugs that were developed with taxpayers’ funding. “Doing nothing sends the opposite message, that it is fair game, open season, for whatever price increases they wish,” he added.
The subcommittee also addressed a broad range of issues, including NIH’s efforts to respond to the opioid epidemic, the Precision Medicine Initiative, data sharing, and research on specific topics such as pain.
Douglas Lowy, M.D., acting director, National Cancer Institute; Walter Koroshetz, M.D., director, National Institute of Neurological Disorders and Stroke; Richard Hodes, M.D., director, National Institute on Aging; Christopher Austin, M.D., director, National Center for Advancing Translational Sciences; Nora Volkow, M.D., director, National Institute on Drug Abuse, appeared with Dr. Collins.