Further Thoughts On NIH Funding

by Patrick Friel | October 12th, 2006

In his editorial, “The Reality and the Promise”, Siegfried Othmer discussed the NIH’s lack of interest in supporting neurofeedback research. The NIH’s failure to pursue investigations into a treatment modality as clearly valuable and underutilized as neurofeedback reflects a larger evolving crisis in biomedical research. The psychiatrist and editor of Medical Hypotheses Bruce Charlton argues that, “it is unlikely that current patterns of medical science funding will yield the hoped-for advances in therapeutics that provide the main justification for expanding the input of resources. Too much expansion, too narrowly channeled, for too long, has probably led to increasing inefficiency, with diminishing returns from ever-greater spending.”Consider, for example, the three largest NIH grants awarded in 2005:

  • $53 million to MIT to “Generate high quality genome sequence”
  • $46 million to Washington University to “Improve informatics tools, produce genome sequence”
  • $33 million to Baylor College of Medicine to “Produce draft sequences of the rhesus macaque and bovine genomes”

Undoubtedly these “Big Science” genomic projects will generate a huge amount of data, which should contribute to the further elucidation of mammalian genetics. However, whether the results will lead to important new treatments for major diseases is seriously open to question. According to Charlton, “there is a spreading disillusion with the Human Genome Project — the biggest and costliest biological venture in history. This was ‘sold’ to the public and political funders as essentially a means of generating major clinical breakthroughs, but these have failed to materialize.” Critics of spending the lion’s share of medical research dollars on genomics have long pointed out that most of the major diseases in advanced countries involve a complex interaction of multiple genes and the environment. Single gene-disease associations in the medical literature are typically quite modest (i.e. individuals with polymorphism X of gene Y have a 20% greater risk of developing disease Z). These associations are simply not strong enough to be the foundation for developing new therapies. And even in the uncommon case when a disease is caused by a single, known gene mutation, therapies may not be forthcoming, as seems to be the case for cystic fibrosis.

It is well known among researchers that NIH funding is becoming more and more monolithic, with huge projects and prominent institutions garnering a greater slice of the pie every year. Investigators running smaller labs, especially those not at big name universities, are struggling for funding as never before. But do giant centralized research empires always give the best bang for the buck? Not necessarily.
Charlton argues that a “golden age” of medical discovery from roughly 1935 to 1965 was followed by a massive expansion in research funding, based on the model that basic research discoveries will inevitably lead to advances in applied science, i.e. treatment: “Although medical breakthroughs do sometimes result from Big Science and ‘basic’ research, when the major advances in medicine are surveyed the most striking aspect is their causal heterogeneity.” He concludes that, “ (a)fter prolonged over-funding of the ‘basic to applied’ model of clinical innovation, and a progressive shift towards Big Science organization, medical research has become increasingly inefficient and ineffective. Although incremental improvements to existing treatment strategies continue, the rate of significant therapeutic breakthroughs has been declining for three decades.”

Important medical discoveries can arise in small-scale settings, where alert and inquisitive clinicians wrestle with unexpected or serendipitous findings. Examples include the discovery of the role of H. pylori in the pathogenesis of peptic ulcers; the delineation of AIDS; the discovery of MPTP-induced Parkinson’s Disease; and of course, Barry Sterman’s discovery of neurofeedback therapy for epilepsy. In the words of Pasteur, “chance favors the prepared mind”.

A problem that is closely related to the NIH’s tilt toward Big Science is the steady stream of media hyperbole about medical progress. In Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises, an academic physician and a professor of public health make the case that our dreams of miracle cures can turn us into patsies: “New tests, devices, or drugs are routinely introduced as ‘breakthroughs’ — when, in reality, many are marginally effective, useless, or even harmful.” (See the websites of Ralph Moss and Merrill Goozner for more on “breakthroughs” and subsequent disappointments.) Over-hyping contributes to at least two problems:

  • A “signal to noise” problem: clinicians are so used to overblown claims from Big Pharma, sometimes aided by academic, NIH-funded “marquee” physicians, that they are prone to throw out the baby (neurofeedback and other valuable innovations) with the bathwater.
  • A financial problem: healthcare resources are absorbed by over-hyped, expensive but “marginally effective, useless, or even harmful” new therapies, crowding out genuinely promising modalities like neurofeedback.

Charlton believes that the combination of marginal successes for ever-greater expenditures, and competition from other social needs, may lead to a collapse in the present medical-industrial research complex. Currently the U.S. spends about 16% of our gross domestic product on healthcare — about twice the per capita rate for other advanced countries — but our national health statistics are nothing to write home about. A number of advanced countries, spending much less per capita on healthcare, have greater life expectancies and lower infant mortalities than the U.S. Our extra dollars feed a gigantic health insurance bureaucracy, Big Pharma, and a steady stream of expensive “cutting edge breakthrough” therapies that often disappoint.
Of course, no one has an invincible crystal ball. Certainly we would all welcome some real Big Science medical breakthroughs. It’s possible, but I’m not holding my breath.

Both the NIH and the U.S. healthcare system present serious cost/benefit problems at a time when funding seems destined to shrink. Healthcare expenditures are expected to reach 20% of GDP within a decade. Health insurance costs threaten to bankrupt major U.S. businesses, not to mention low-income families. And of course U.S. military expenditures and budget deficits are setting records. Simply paying our healthcare bills, let alone paying down the federal budget deficit, may start to crowd out biomedical research. Currently, NIH budget growth is flat, and Charlton could be right that in the future, NIH budgets may decline. And if funding does indeed decline, vested Big Science interests are likely to pursue an even greater share of research dollars.

It seems that neurofeedback and other valuable therapies (acupuncture is another example) are being forced into a parallel universe, by the lack of interest and support from the mainstream Big Science/Big Pharma/Big Insurance medical-industrial complex. The evidence cited here suggests that this trend may continue, as the crisis in healthcare and biomedical research grows. The first priority for those of us who have benefited from neurofeedback, as patients, parents etc., is to do whatever we can to support the work of the core experts and institutions in the field. The EEG Institute stands out as one of those most worthy of our support.

Since we apparently haven’t been granted passage on The Titanic, we need to focus on keeping our smaller vessel provisioned and afloat!

Patrick Friel worked as a member of an NIH-funded, University-based team investigating new antiepileptic drugs from 1970-1988, when he left to pursue his current career in forensic toxicology.


Berenson A. Hope, at $4,200 a dose. The New York Times, October 1, 2006.

Bruce Charlton’s website: http://www.hedweb.com/bgcharlton/

Charlton BG, Andras P. Medical research funding may have over-expanded and be due for collapse. QJM. 2005 Jan;98(1):53-5.

Charlton BG. Boom or bubble? Is medical research thriving or about to crash?
Med Hypotheses. 2006;66(1):1-2.

Deyo RA, Patrick DL. Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises. New York: American Management Association, 2005.

Freudenheim M. Health care costs rise twice as much as inflation. The New York Times, September 27, 2006.

Goozner M. The $800 Million Pill. Berkeley: University of California, 2004.

McCook A. The inequality of science. The Scientist 2006; 20(8):26-33.

Merrill Goozner’s website: http://www.gooznews.com/

Moore TJ. Deadly Medicine: Why Tens of Thousands of Heart Patients Died in America’s Worst Drug Disaster. New York: Simon and Schuster, 1995.

Ralph Moss’s website contains extensive information on cancer therapies, including recent “breakthroughs”: http://www.ralphmoss.com/

Leave a Reply