How The NIH Head Tries to Explain Why NIH Funding Does Not Improve Health

Executive Summary

• The quotes from Dr. Francis Collins illustrate how the NIH tries to divorce itself from health outcomes.

Introduction

While reviewing an interview given by the head of the NIH, Dr. Fancis Collins, I found an interesting question asked by the NPR interviewer. How Dr. Collins responded is the topic of this article.

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Dr. Francis Collins On the Lack of Correlation Between NIH Spending and National Health

Interview Question

In your 12 years as director, the NIH has worked on developing cures and getting them from the lab to patients faster, and the agency’s budget has grown.

But, in that time, Americans haven’t, on a broader scale, gotten healthier. They’re sicker than people in other countries across the board, all races and incomes. When you were sworn in in 2009, life expectancy was 78.4 years, and it’s been essentially stuck there.

Does it bother you that there haven’t been more gains? And what role should NIH play in understanding these trends and trying to turn them around? – NPR Interviewer

Dr. Collins’ Response

Well, sure, it does bother me. In many ways, the 28 years I have been at NIH have just been an amazing ride of discoveries upon discoveries. But you’re right, we haven’t seen that translate necessarily into advances.

Let’s be clear, there are some things that have happened that are pretty exciting. Cancer deaths are dropping every year by 1 or 2%. When you add that up over 20 years, cancer deaths are down by almost 25% from where they were at the turn of the century. And that’s a consequence of all the hard work that’s gone into developing therapeutics based on genomics, as well as immunotherapy that’s made a big dent in an otherwise terrible disease.

I do not think that Dr. Collin’s description is accurate.

Cancer prevention and treatment is one of the failing areas of medicine. What Dr. Collins leaves out is that more people get cancer than ever before. While MDs and hospitals are interested in treating cancer, they don’t seem very interested in asking why cancer is so much more prevalent than ever before. The NIH has overwhelmingly focused on treatments that will enrich pharmaceutical companies and medical equipment manufacturers.

Furthermore, the most effective way to reduce cancer is to focus on prevention. This would include better regulating pollutants and improving the population’s immune systems. However, this does not interest the NIH.

The quote continues…

But we’ve lost ground in other areas, and a lot of them are a function of the fact that we don’t have a very healthy lifestyle in our nation. Particularly with obesity and diabetes, those risk factors have been getting worse instead of better. We haven’t, apparently, come up with strategies to turn that around.

Dr. Collins sounds like there is nothing the NIH can do about this. The NIH has $40 billion it can spend, rather than primarily approving research that leads to advanced solutions that benefit pharmaceutical companies. The NIH could choose to agree on research into things that would be more effective at improving health outcomes. Something very obvious is why doesn’t the NIH support research into single-payer health care in the US? These same systems provide far better health outcomes in many countries and would undoubtedly improve health outcomes in the US. However, this is not of interest to the NIH, even though it is one of the most important things the US could do to improve health outcomes. It may hold the promise of improving health, but it does not enrich elite interests connected to the NIH. According to the WHO, the US ranks 37th in health outcomes. Countries that one would not expect, including Colombia, Saudi Arabia, the United Arab Emirates, Morocco, Dominica and Costa Rica all rank higher than the US. Not only to all of these countries spend far less per person on health care…

In the case of Costa Rica, they spend 1/5th as much per person.

…however, Costa Rica also does not spend tens of billions as the US does on the NIH for health research, that is funded, with the idea that it will lead to improvement in the health of the US population.

Why is that?

Dr. Collins continues…

On top of that, the other main reason for seeing a drop in life expectancy — other than obesity and COVID — is the opioid crisis. We at NIH are working as fast and as hard as we can to address that by trying to both identify better ways to prevent and treat drug addiction, but also to come up with treatments for chronic pain that are not addictive, because those 25 million people who suffer from chronic pain every day deserve something better than a drug that is going to be harmful.

The idea that Dr. Collins will not call out pharmaceutical companies like Purdue Pharma is highly concerning and is a topic I cover in the article How Purdue Pharma Created the Opoid Epidemic.

Dr. Collins continues…

In all of these instances, as a research enterprise — because that’s our mandate — it feels like we’re making great progress.

But the US is not making progress. Obesity is higher than ever. The overall health of the US population has declined over the past several decades. There may be scientific progress being made, but the health of the US is not improving but instead getting worse. When Dr. Collins refers to progress, he seems to substitute technological progress for progress in health outcomes.