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President Donald Trump’s decision to retain Francis S. Collins as NIH director may help protect the agency from looming cuts to medical research funding, research advocates told Bloomberg BNA.
“It would be difficult to underestimate the significance of this,” Ellie Dehoney, vice president of policy and advocacy for Research!America, told Bloomberg BNA on June 7. “I don’t just mean for patients and for the research community. Because of the confidence in Dr. Collins—and the increased probability because of this that there will be increased funding for NIH—I think it says a lot about things like our fiscal future because of skyrocketing health-care costs.”
Collins served as NIH director for nearly the entire Obama administration and was held over by the Trump administration in January. He appears to have passed a trial period as one of the few Obama appointees who will keep his job.
“The previous thing was day-to-day, and this is not,” Lizbet Boroughs, president of United for Medical Research, told Bloomberg BNA on June 7. “It makes an enormous difference.” The continuity of Collins‘s leadership “will definitely send a signal that the United States continues to be a leader in biomedical research,” she added.
Dehoney of Research!America said she doesn’t expect Trump’s decision to impact Collins’s leadership style. “Dr. Collins is a very conscientious leader so I don’t think he treated his decision-making any differently,” she said. “He’s going to continue to be an extraordinary leader.”
The average term of NIH director since the 1950s has been about six and a half years. Collins is on track to be one of the longest serving NIH directors since World War II. By comparison, James Shannon served as the agency leader for 13 years, from 1955 to 1968.
Victoria A. Harden, a retired NIH historian who continues to volunteer at the agency, told Bloomberg BNA the NIH directorship didn’t become a presidential appointment until the passage of the National Cancer Act in 1971 and didn’t require Senate confirmation until the National Cancer Act Amendments of 1974. Prior to those laws, the surgeon general generally appointed the NIH director.
“Besides Dr. Collins, the only presidentially appointed NIH director since World War II who has continued from one administration to another was Dr. Donald S. Fredrickson, appointed by President Gerald Ford in July 1975 and was retained by President Jimmy Carter when he took office in January 1977,” Harden said in a June 7 email. "[S]hould there be a second Trump administration and Dr. Collins stayed on all four years, he will have served 16 years, at which time he would indeed be the longest serving NIH Director since World War II.”
The White House said in the June 6 announcement, “Dr. Collins is a physician-geneticist noted for his landmark discoveries of disease genes and his leadership of the international Human Genome Project, which culminated in April 2003 with the completion of a finished sequence of the human DNA instruction book.”
Mary Sue Coleman, president of the Association of American Universities, said in a June 7 statement, “Now, more than ever, it is imperative that a leader of his caliber oversee the key initiatives at the NIH, which have immeasurable impacts on science, discovery, and public health.”
The White House announcement comes at a time the NIH is undertaking some of its most ambitious projects, such as the moonshot effort to accelerate cancer research and the million-person precision medicine study.
“I am honored to continue as the Director of the National Institutes of Health and consider it a great privilege to serve at a time of unprecedented opportunity to advance health and relieve suffering through biomedical research,” Collins said in a June 6 statement. “I am grateful for the President’s vote of confidence in my ability to continue to lead this great agency.”
Now that he has successfully kept his job, will Collins be just as successful in securing NIH funding?
“It’s important, certainly, to have somebody of his stature,” Boroughs told Bloomberg BNA, adding the agency is an international leader in medical research, and Collins’s background as a scientist who led the Human Genome Project adds credibility.
Medical research in general and Collins in particular both have broad support from both parties, as evidenced by the 21st Century Cures law ( Pub. L. 114-255). The biomedical innovation bill—which provides the NIH with an additional $4.8 billion fund over five years— cleared Congress last winter with the support more than 90 percent of lawmakers.
“Collins is well liked by key Senate leaders,” Brian Rye, Bloomberg Intelligence senior health-care analyst, told Bloomberg BNA in a June 7 email. “The proposed cuts weren’t going to happen anyway, as both Democrats and most Republicans support funding basic medical research, and Collins’s retention only solidifies that further.”
Indeed, Sen. Lamar Alexander (R-Tenn.) called Collins “one of President Trump’s best appointments.” The Tennessee senator’s support is important because Alexander is the chairman of the committee that oversees the NIH’s programs and sits on the appropriations panel in charge of NIH funding.
“There’s nobody better qualified than Francis Collins to help accelerate the medical miracles that have the potential to help virtually every American family,” Alexander said in a June 6 statement.
Despite his popularity, not all lawmakers support the decision. Rep. Jim Banks (R-Ind.), who sent a letter May 21 asking Trump to replace Collins, expressed disappointment. “Dr. Collins’s support of embryonic stem cell research, along with his comments that cloned embryos do not deserve the same moral protections as ‘naturally generated embryos,’ make him a less than an ideal fit for a pro-life administration,” Banks said in a June 7 statement.
The NIH has come out a winner in the last two appropriations cycles with two consecutive $2 billion increases that put the agency’s budget at more than $34 billion. It was a move by Congress to reverse a dozen years of flat funding in which the agency lost nearly a quarter of its purchasing power.
But that reversal would be uprooted by the White House budget proposal released in May, which would drop the NIH’s budget from $34 billion to $25.9 billion in the 2018 fiscal year that begins Oct. 1.
Collins has been clear in previous congressional testimony that a stable funding trajectory for the NIH is the best way to realize the promise of the new cures and treatments. But as an administrative appointee, he would have to testify on behalf a budget that would bring the agency to its lowest funding levels since the 1980s.
“We cannot expect Dr. Collins not to honor his leader’s wishes, and so that would be shortsighted of us,” Dehoney said. “But he can certainly be asked what the funding needs are.”
Boroughs said: “In the past two or three years, he has done a tremendous job of making sure that elected officials come out to NIH and see the great things NIH is doing.”
“He’s also done a lot more to reach out to patient groups than previous NIH directors have,” Boroughs said.
To contact the reporter on this story: Jeannie Baumann in Washington at email@example.com
To contact the editor responsible for this story: Randy Kubetin at RKubetin@bna.com
The White House announcement is available at http://src.bna.com/pBz.
Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.
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