Today, I’m writing to ask for your help responding to a proposal that could undermine liver disease research at the National Institutes of Health (NIH). House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) released a framework to reform the NIH, which would be massively disruptive to the agency and the research that it funds. The framework was developed without the benefit of public hearings or consultation with NIH leadership and stakeholders. Some of the key changes include:
- Consolidating the 27 institutes and centers into 15, including:
- Making the National Institute of Diabetes and Digestive and Kidney Diseases part of a new National Institute on Body Systems Research along with the National Heart, Lung, and Blood Institute and the National Institute on Arthritis and Musculoskeletal and Skin Diseases; and
- Merging the National Institute on Alcohol Abuse and Alcoholism with the National Institute on Drug Abuse into a National Institute on Substance Use.
- Capping the number of concurrent awards each primary investigator can have at three.
AASLD is gravely concerned that NIH’s investment in liver disease research will suffer substantially if this policy is enacted as proposed and will be submitting comments by the deadline of August 16. I’m asking for you to send your concerns to Chair McMorris Rodgers by highlighting the impact the policy would have on your research. We need to make sure that our concerns about this policy developed without the benefit of a robust reauthorization process are heard.
Below, we have included some general concerns about the policy that you can include in your message. Should you use these, we ask that you personalize them with examples from your experiences with liver disease research funded by NIH. Your comments should be submitted to NIHReform@mail.house.gov by Friday, August 16.
Key Points
- Introduce yourself as a member of AASLD and a physician-scientist, highlighting your area of research.
- We recognize that NIH has been operating under an expired authorization and support a bipartisan and bicameral reauthorization process that includes public hearings, opportunities for public comment, and consultation with NIH leadership.
- The House Labor, Health and Human Services, Education and Related Agencies bill for FY 2025 adopts the institute and center consolidation from the Energy and Commerce Committee Chair’s reform framework. Reauthorization of a $48 billion agency should not be based on a single reform framework document that has not been subject to public hearings and a thorough reauthorization process.
- We share the goal to increase collaboration and innovation and break down silos at NIH but do not believe the policy to consolidate 27 institutes and centers into 15 will have the intended effect. In fact, this policy may hamstring the NIH’s ability to advance health outcomes. It is not clear what scientific and public health principles the proposed changes to the institutes advance.
- For example, combing NIDDK, NHLBI, and NIAMS into a new National Institute on Body Systems Institute may not break down silos as the Chair intends. These institutes already have broad missions, and less common or orphan diseases, like chronic pancreatitis, may be overlooked in favor of more common conditions, like diabetes and hypertension. This concern will be even more pressing if the new combined institutes do not have program officers who have expertise in the full range of conditions covered by the existing institutes.
- This framework proposes to combine NIAAA and NIDA into a National Institute on Substance Abuse. This has already been considered and rejected by NIH. While there is overlap between the science of alcohol addiction and drug addiction, NIAAA examines addiction and the metabolic aspects of liver disease. This important area of science may be overlooked in the proposed new institute at a time when alcohol is the leading cause of liver disease in the United States.
- Other solutions, including requiring each institute and center set aside a percentage of their funding for collaborative research like U awards, may be more effective at breaking down silos and promoting innovation and should be carefully considered.
- The framework proposes capping the number of awards a primary investigator can receive at three. We share the Chair’s goal for NIH to support more researchers, but this policy may have unintended consequences.
- A primary investigator’s percent effort may not be consistent across awards, so a cap of three will not provide uniform support for all primary investigators.
- Many primary investigators support early-stage investigators and help move them closer to research independence through their awards. With less support for primary investigators, this may have the unintended consequence of setting young investigators back rather than advancing their research careers.
- We welcome the opportunity to explore other solutions to get more researchers, including physician-scientists, into the research pathway.
Thank you for your continued support and commitment to ensuring the future of liver disease research at the NIH. Together, we can make a significant impact.
Sincerely,
W. Ray Kim, MD, MBA, FAASLD
AASLD President