Ebola v. Obesity: The Politicized NIH

NIH Director Francis S. Collins, with President Obama
October 20, 2014

For over a year, the Washington Free Beacon’s Elizabeth Harrington has been documenting research grants provided by the National Institutes of Health to recipients like an obvious conman who said he wanted to bring origami condoms to the world ($2.5 million) and teams studying if obese people could be persuaded to lose weight by having the government text message them ($2.7 million). Last week, with the NIH’s budget in the spotlight—courtesy of the director of the NIH himself, Dr. Francis Collins, who claimed that an Ebola vaccine would likely exist today were it not for a "10-year-slide in research support" for his organization—Harrington wrote a round-up of her work on this issue, observing that the total amount of absurd NIH funding she had chronicled amounted to nearly $40 million, all of which would obviously have been better spent on an Ebola vaccine—or on cancer, or on HIV/AIDS, or on any number of worthy medical causes.

Not so fast. On Friday, Sam Stein of the Huffington Post wrote about the funding issue at the NIH, during the course of which he described Harrington’s work as part of a series of conservative "attacks" that can "produce guffaws." His piece, on the other hand, set out to navigate the political Charybdis of the right, which claims that the NIH has plenty of money and wastes it, and the Scylla of the left, which claims that people are dying of Ebola because Republicans cut funds for the NIH. Stein’s middle course is meant to reveal that "the issue is far more complex."

Stein’s piece provides insight into thus-far failed efforts by the NIH to produce a vaccine, and is particularly interesting when he quotes the director of public affairs at the American Society for Biochemistry and Molecular Biology saying he is worried Francis Collins has "opened up the NIH budget process to politics in a way I truly wish he had not."

Moreover, Stein’s own defense of the NIH’s budget process is worth taking seriously for the insight it offers into  both the progressive view of government and the politicization of theoretically apolitical federal bureaucracies.

Says Stein:

These attacks may produce guffaws. But they gloss over the basic structure of the NIH grant process. For starters, it’s difficult, if not impossible, to predict what the big biomedical need will be five years down the road. NIH prioritizes certain subjects. But it also tries to spread resources to many fields.

Second, it’s scientists, not bureaucrats, who are doling out the money. Every year, experts in specific fields volunteer to be on an NIH study section. They sit in a room, review grant proposals, and score them based on scientific merit. Those scores are sent to NIH, which establishes the pay lines for what gets funded and what doesn’t. Sometimes, it’s the odd-sounding project that's judged to be meritorious. Sometimes, that project produces the most promising medical advance.

"One of the biggest issues we face in Congress is the idea that federal research agencies should fund only science with a specific practical purpose," Barry Toiv, vice president for public affairs at the Association of American Universities, said in an email. "That is not how science works. If this had been the practice ... the list of lost or delayed technologies and medical advances would be staggering. For example, we’ve reduced deaths from heart disease and stroke by more than 60 percent and transformed HIV/AIDS into a manageable illness in good part through the serendipitous results of unrelated research. ... Rather than worrying about what sounds funny or obscure, we need to let the world’s greatest research enterprise do its job."

So the budgeting process works just fine, thank you very much, because scientists, and not politicians, are in charge. These scientists are noble and impartial stewards of the public good, unlike the hacks in Congress, who are vulnerable to shifting political circumstances and all too accountable to a voting public that doesn’t understand "how science works." It is too bad that there is, as yet, no Ebola vaccine, but this is not the fault of the sort of ridiculous funding Harrington highlights.

Indeed—to develop the argument in a direction that Stein does not, but which he implies—is the funding even all that ridiculous? Those scientists sitting in their room and scoring grant proposals for, say, how to help Americans fight obesity or quit smoking, could clearly justify such research with the observation that the complications of obesity and smoking kill far more Americans every year than Ebola has or (we hope!) ever will. The resources of the NIH should thus be directed according to the numbers, to the science.

But such reasoning is highly problematic, and the nature of the research projects Harrington documents gives an indication as to how. For example, consider this account of the federal government’s efforts to modify Americans’ unhealthy diets:

The Dietary Guidelines Advisory Committee on Friday emphasized the need for the group to institute "population behavior change" in order to engineer healthier Americans.

DGAC Chair Barbara Millen said the upcoming report would serve as the "foundation for public policy and food nutrition, physical activity, and health-related areas." The group will release new recommendations for federal food policy in the 2015 report. …

One example of a behavioral intervention was highlighted during the morning session. Deborah Tate, a cognitive-behavioral psychologist at the University of North Carolina’s Gillings School of Public Health, suggested ways the government could use text messages to get people to stick to their diet.

Tate’s presentation, "Behavioral Strategies and Delivery Approaches to Changing Diet and Activity for Weight Control," offered example texts that could be sent to obese people.

"Remind yourself of your motivations for losing weight. If you are finding it hard to stay motivated, write down one reason you want to lose weight," one read.

"Try to eat high fat foods less often. This is a good way to cut calories," said another.

And finally: "There are 1440 minutes in a day. Try to find at least 10 to exercise!"

Tate received $1,227,995 from 2002 to 2005 from the National Institutes of Health to study "Internet behavior therapy for treating obesity."

Her findings for a trial "Text Message–Based Intervention for Weight Loss" were that text messages "might prove to be a productive channel of communication to promote behaviors that support weight loss in overweight adults."

In addition to Tate’s research, the NIH also spent $1,479,072 between 2009 and 2011 for a separate study, "TEXT4DIET."

There is a creepy, intrusive quality to everything about this story. Scientists may have concluded that obesity is a bad thing, and that text messages funded by the feds might have a chance at reducing obesity. Lower rates of obesity would be a good thing.  Therefore the government should fund it.

But just because an outcome is good doesn’t mean that the federal government has a mandate to pursue it, let alone by means that are borderline Orwellian.

An implicit premise of the sorts of people happy to spend millions in taxpayer dollars to fund such initiatives is a progressive hope that, with science at its side, government technocrats can create a better world where human suffering is reduced to an absolute minimum. The real threats to Americans, by the numbers, aren’t the scary but statistically insignificant specters of things like Ebola, but Americans themselves, with their poor eating habits and life skills. The government is here to help them, whether they want the help or not—and with their own money, no less!

The reason stories such as these hit a nerve with conservatives is that many Americans don’t think the government is there to protect them from their own choices, or from every bad outcome that could afflict them. They believe that threats like terrorists who commit mass murder, or deadly viruses that kill you by liquefying your organs and that are apparently quite communicable, are more properly the concern of the government, regardless of what the numbers say.

The paternalism implicit in the NIH’s absurd grants should be rejected in principle. But it is also noteworthy that the grants Harrington has documented are not only ridiculous from a point of view of principle. In fact, they rather clearly show that—far from being the disinterested technocrats of progressive dreams, answerable only to science and a conception of the public good honed in the better universities—the scientists at the NIH regularly make funding decisions that are highly politicized.

Is the best way to combat obesity—conceding for argument’s sake that such a goal is the proper business of the feds—really to study the alleged problem of lesbian obesity? If the government has a legitimate goal in helping old people feel less lonely, is the best way to pursue that goal recruiting "450 minority elders" to join choirs (at a cost of $2 million!)?

Of course not. The scientists applying for such grants are, on the evidence, conventional liberals, beholden by their prejudices and self-interest to the electoral coalition that backs the Democratic Party, even if they conceive of themselves as impartial technocrats. For all the substantial good the NIH has done over the years, the sort of funding Harrington documents demonstrates an obvious weakness on the part of theoretically impartial scientists for grant proposals that are trendy and politically correct.

That they cannot detect how absurd these proposals are, or predict that most Americans might question their scientific value, emphasizes the problem. It might be suggested that $40 million is chump change for both the NIH and the federal budget in general. But to most taxpayers such a sum isn't insignificant—and, in any event, the Ebola vaccine project that Stein describes was only funded to the tune of $5.8 million.

As Stein points out, some members of the scientific community are worried that Francis Collins’ complaints about the NIH budget might backfire. They are concerned that Congress will now more closely scrutinize the NIH’s budget, and insist that taxpayer-funded research be directed not towards what the scientists, operating with exquisite discretion in their committees, determine to be worthy, but towards what the elected representatives of the taxpayers determine to be worthy.

Stein’s sources argue that this would be a politicization of the NIH. Harrington’s work shows that the ship of politicization sailed a long time ago.  Greater scrutiny from the Congress would not harm the place, but help it by providing something which is obviously needed: accountability to the American people.