RUTHFULLY YOURS

During the first 60 years of the 20th century, United States life expectancy rose, on average, by 0.37 years per year. After 1960, the rate of improvement suddenly dropped by more than half to 0.15 years per year before the Covid-19 effects.

A significant factor in this slowdown was rapid expansion of and mismanagement by the National Institutes of Health (NIH). During the first 60 years, NIH spending increased by $139 million per year in inflation-adjusted 2022 dollars. After 1960, it increased by five times that amount — $703 million per year:

The nomination of Jay Bhattacharya to lead NIH, with his openness to change and dedication to rigorous science,  offers an opportunity to fix the agency’s failures. There are talented scientists funded by NIH grants achieving important breakthroughs. Unfortunately, the size and failures of NIH result in wasted money and too-slow progress toward improved health.

NIH applies a “pipeline” model to research where scientists pick their topics, often focusing on what they consider “basic” questions. Experience shows that pipeline research is less innovative and effective in delivering results than the alternative “mission” research model that begins with an objective such as “eliminate polio.” Most privately funded research follows the mission model, with better results.

In the private sector, when research does not yield timely useful results, leadership will require changes. NIH budgeting is driven by activity, not results, and almost never references actual health improvements. The expenditures are justified in terms of the number of projects funded, the number of people paid, or the number of meetings held.

NIH also reduces the effectiveness of private-sector research by “crowding out.” Government funding hires scientists away from more-effective mission-driven private research. It also erects barriers to creative alternative investigations because when government spends $100 million on a subject, that can discourage a $10 million investment on an alternative.

Amazingly, NIH does not begin its budgeting by identifying the most pressing health needs and then targeting spending to reduce the associated morbidity and mortality. That is not just carelessness; NIH explicitly refuses to do the work. After it makes grants, only then does it use text-processing software to assign grants to classify each grant from a list of 315 categories.

Cardiovascular diseases are the deadliest, causing 20.0 percent of American deaths, but they receive only 6.8 percent of NIH research funding. Cancers cause only 8.8 percent of deaths, but NIH spends 20.8 percent of its funds on cancer. If there is a good reason for that disparity, NIH explicitly refuses to provide it.

Funded projects are often deficient. The most serious project-level failures are those that reject science. Dr. Marty Makary of Johns Hopkins School of Medicine has highlighted one NIH project that explicitly violated scientific methods, resulting in serious harm to millions of women. Hormone-replacement therapy had a long history of both helping women feel better and reducing their chances of fatal heart attacks, Alzheimer’s, and bone fractures. Results from an NIH-funded project showed in unambiguous terms that the therapy had no effect on the incidence of breast cancer. But the project leader, backed by NIH management, published and continued to promote the claim that the treatment caused additional cancer. That false claim caused doctors to stop this highly beneficial treatment for 20 years.

Our research has identified other less dramatic but important cases where NIH has violated scientific methods. NIH has even funded projects that explicitly seek to cite “indigenous knowledge,” “cultural tradition,” or “life experience” as if they were real scientific evidence. For the past 500 years, humanity has labored to replace indigenous knowledge about a flat earth, matter composed of four elements, and a geocentric universe with real knowledge. Now, NIH is permitting projects to use — or even demanding that they use — failed types of nonscientific “evidence.”

Some NIH projects endanger our liberty and safety. “Shaken baby syndrome” is characterized by subdural hemorrhages, brain swelling, and retinal hemorrhages. Scientific evidence shows violent shaking can create those signs. But it also shows that genetics, diseases, and accidents can cause the same indications. NIH has weighed in so heavily on one side of this important issue that it has stifled necessary discussion of it, and it continues to promote the misleading single-cause view. It has adopted a new misleading term of “abusive head trauma” for the signs, a label that is used by activists who take children from parents and even put them in prison; in one case, the label was used to help sentence a father to death.

NIH also funds projects seeking to develop and implement firearm controls to limit our freedom to keep and bear arms, despite a congressional prohibition on grants for such research.

Some NIH projects have no relationship to identifying the causes, treatment, and cures of disease. They seek to entice, incentivize, or compel individuals to adopt behaviors such as signing up for “voluntary” programs to manage their prescriptions or engaging in safe sex practices. In none of these cases is any medical question at issue; the projects use government force to increase — or coerce — compliance in choices that should be voluntary. There was even a project that trained providers to code their insurance claims to get higher reimbursements. Multiple projects are funded in foreign countries and are of no value to American health.

Other projects are simple waste. NIH spends money on smallpox research, a disease that has existed nowhere on the planet in the past 46 years. Most projects on nutrition are another waste. The government has been systematically wrong about nutrition for more than 50 years, so why continue? Nutritional issues do not require much additional research. We already know what to do in most cases; people simply choose otherwise.

There is also incredible waste in pursuing “diversity, equity, and inclusion” projects. NIH spent grant money to test whether DEI improved research. The resulting data showed no value whatsoever, although the authors continued repeating their DEI beliefs after failing to prove they were true.

There are many opportunities to improve health research in the United States through better NIH quality assurance and reduced government domination of the research. We’ve identified some of the big hitters above, but our research has found still more.

John Early is a mathematical economist and was formerly an assistant commissioner at the Bureau of Labor Statistics. Terence Kealey is a professor of clinical biochemistry at the University of Buckingham. Both are co-authors of an upcoming book on NIH from the Cato Institute, where they are adjunct scholars.