From the Deputy Director for Intramural Research

Bold and Robust Science

The NIH continues to prevent the transition from health to unhealth

We often say that, in the NIH Intramural Research Program (IRP), we can do a kind of research that would be challenging at best to do anywhere else. Are we deluding ourselves, or is this statement actually true? If true, do we leverage this capability to create and share something unique? In the answers to these questions lie the raisons d’être and marketing strategy for the IRP, the promise of the research conducted on our campuses for the populations we serve, and the potential for collaboration and synergy between NIH IRP research and that done in universities and industries around the United States and the world.

Thinking about this is insomnia-worthy, and many of you have noticed I have looked more tired than usual recently! Since the founding of what is now the NIH, the scientific community and environment around it has changed vastly. Universities now have sizable endowments and physical structures devoted to research. Industry has forged partnerships with universities and government to derisk the research it does by collaborating with university colleagues, funding university-based developmental research, or purchasing licensing rights to promising basic and developmental findings and assets. Research institutes sit within and side by side with patient care facilities and hospital systems with enormous patient numbers that combine in mega-consortia in ways that the Clinical Center could never hope to do. No longer is NIH the only bastion of research in the generic or the only home of research excellence and innovation.

What makes the research that can be done only at NIH unique is largely the way in which NIH IRP researchers and research are evaluated and resourced. Whereas extramural researchers write grant applications based on individual projects and need to demonstrate the worthiness and feasibility of performance of those future projects to obtain funding, intramural researchers present their entire portfolio every four years and are largely funded for the future based on their accomplishments in the past. In other words, instead of funding projects, the IRP funds people and teams.

What this means is that IRP investigators can pursue projects that are not a “sure shot.” They can pursue longitudinal projects that might take longer than the 4- or 5-year duration of a R01 grant. This difference enables IRP investigators to do such things as first-in-human studies or studies that require invention of novel instrumentation or methods that might not work at first, or studies that phenotype a cohort of patients from conception to late adulthood.

What of the Make America Healthy Again (MAHA) agenda? Is NIH uniquely positioned to contribute to this national enterprise? From the standpoint of the study of chronic disease and its basic mechanistic underpinnings, we are already leveraging our unique evaluation system and resources to do this. At last count, with of course some overlap, 86 intramural investigators are working on diabetes; 64 working on obesity; 31 working on renal failure; and 25 working on stroke. Similarly, I counted 205 investigators working on aging; 121 working on chronic infection; 112 working on inflammation; 72 investigators working on autoimmunity; 67 investigators working on environmental exposures; and 70 working on oxidative stress.

The real crux, however, of ensuring the health of the people we serve is preventing the transition from health to unhealth. What better environment is there in which to detect, characterize, and work toward preventing that transition than one in which the study of life-course cohorts is not only possible, but facilitated and rewarded?

What better environment is there in which to take chances, be audacious, and juxtapose ideas, tools, and mechanisms from different fields than one in which people and teams—and innovation and creativity—are the currency in which value is judged? Only through such studies that engage the communities around us; follow and deeply phenotype their biological, psychological, social, and environmental characteristics; and determine the turning point from health to unhealth and its mechanistically verified precipitants will we be able to keep America and the world healthy.

We must ensure the robustness and boldness of the NIH IRP; refuel the robustness and boldness of the complementary research communities in academia and industry; and restore the robustness and boldness of the teams we enlist to critique and hold accountable all components of the research enterprise. Our nation and the world are depending on us.