Well, I think it's 7:00 and I like to be prompt and the good doctor is here. So, I think it's time to start. Uh thank you, Dr. Bhattacharya, and congratulations on your new role as director of the NIH. Thank you for appearing before the subcommittee today to discuss how the fiscal year budget of 2026 will continue efforts from NIH to reduce illness, enhance health, continue land-breaking or unbelievable research and lengthen the lives of all Americans. My home state of West Virginia, as we have talked, is faced with many complex health challenges. I know that if we work together and make wise investments and focus on what really matters, we can create positive momentum towards eliminating these challenges. Fostering NIH collaboration with smaller and rural states is critical. And one of the strengths of the NIH Idea program, which many of us are very interested in. This program provides funding to 23 states, including West Virginia, that historically have received little to no federal research funding. The Idea program and other NIH funding streams have been instrumental for Marshall University, West Virginia University, and other institutions in my state in developing world-class research in neuroscience, cancer, stroke, vision, and addiction science. Researchers throughout my state of West Virginia are making significant contributions to biomedical research in areas ranging from cancers to Alzheimer's disease to substance abuse orders. I look forward to hosting you in West Virginia soon to see firsthand all the amazing research that is being done across our state. This will be a challenging year for appropriations, yet supporting biomedical research is a priority for me and has long been a bicameral, bipartisan priority for Congress. The United States leads the world in biomedical innovation, and I, along with many of my colleagues on this committee, think it is important that America remains the leader in biomedical innovation and research. Investing in biomedical research has proven to save lives while exponentially strengthening the United States economy. I look forward to hearing from you how this budget request would continue to advance this critical research and innovation. The NIH is a driver of economic growth funding more than 94.58 billion dollars in national economic activity last year. In my small state, what NIH supported over 700 jobs and 147 million in economic activity in 2024 alone. For almost a decade, this committee has supported research towards the goals of finding treatments and a cure for Alzheimer's disease. This goal is very personal to me, as you know, since both of my parents lived with and eventually succumbed to this disease. And I can look out behind you and see in the audience that many folks here are extremely interested in that area of research. These investments have allowed NIH to fund research into a wide variety of potential causes of the disease and build evidence for prevention based on a healthy lifestyle. NIH funded research on the amyloid protein led to the development of the FDA approved Alzheimer drugs that were released in '23 and '24 to slow progression of the disease. All of this research is very important and I look forward to working with you to continue robust and diversified Alzheimer's disease research. NIH funded research is also behind many of the more than 600 new cancer treatments that the FDA has approved over the last 20 years. As a lead sponsor of the Childhood Cancer STAR Act with Senator Reed, I look forward to hearing about your priorities and advancements to combat cancer and grow our clinical trial networks, especially among our children. Although we are making positive strides, substance abuse remains an issue in my state. All right, I look forward to hearing more from you about how combining the National Institute of Drug Abuse into a new National Institute on Behavioral Health will enable this important work to continue. I've heard from many university leaders from schools ranging in size, location, and subject about the impact of changes being implemented at NIH. These institutions are the reason America has kept the edge in biomedical research and innovation. As with many changes in leadership, there seems to be a heightened sense of concern and confusion that diverting resources from research will result in a less healthy America. And I hope today we can work to come to a better understanding. We have a difficult task ahead of us this year, but it is my hope that we will come together just as we have done in prior fiscal years to use our limited resources in the most effective and efficient way to support the health and well-being of all Americans. Dr. Bhattacharya, I look forward to your testimony, and I will now turn to my ranking member, Senator Baldwin, for opening statement.
Thank you, Chair Capito. Good morning. Over the last few months, this committee has heard from patients, from families, researchers, and experts about what is happening at the National Institutes of Health. It's been one consistent message that this administration is cutting off life-saving research. And if this administration has its way, it will dismantle the US biomedical research enterprise. That would be devastating for millions of American families counting on new life-saving treatments and cures for terrible diseases. NIH makes the United States the global leader in biomedical research and innovation. NIH research contributed to 354 out of 356 drugs approved by the US Food and Drug Administration between 2010 to 2019. Simply put, without NIH, there would be no cancer immunotherapy, no overdose reversal medication, no cutting-edge treatments. NIH-funded research has saved millions of lives and significantly reduced death rates from common cancers to rare diseases. It has produced what can only be described as miracles. Like last month, when American doctors made history with the first successful personalized gene editing treatment in a 9 and 1/2-month-old baby boy, curing him of a rare, life-threatening genetic disorder. Congress spent nearly 100 years building up NIH as the world's premier biomedical research agency, and investing in research infrastructure at thousands of institutions nationwide, which are fueling the development of state-of-the-art treatments that wouldn't have been imaginable just decades ago. But, as long as it took to build this, this administration has shown just how fast it can all be torn down. I'm not just talking about the president's catastrophic budget request for next year. I'm talking about what NIH is doing right now. If we don't stop NIH from going down the road it's on, I am deeply concerned it will wreak irreparable harm on biomedical research in this country, and millions of American families counting on it. To date, NIH has taken the completely unprecedented step of terminating 2,370 active grants and 4.9 billion dollars in funding. It has significantly delayed the awarding of new grants and continuation grants. It has prevented research institutions from accessing their existing grant funds. Biomedical research can't just be turned on and off on a whim. These delays and terminations aren't just debilitating for scientists, they are also derail research on everything from Alzheimer's disease to cancer to diabetes. Decisions about which medical research grants should be funded or terminated are for the first time in history being made by political appointees, most with absolutely zero scientific training or expertise. I'm very concerned about the sudden proliferation of political appointees at NIH and other actions this administration has taken to politicize scientific research, like allowing Dodge to decide which grants get terminated and which grantees actually get paid. Injecting politics into NIH will make American science less rigorous, less credible, and less competitive. Everything that is happening at NIH is being led by political interests, not by science. I want to mention a few examples because details here matter. NIH has delayed 65 million dollars in funding for 14 Alzheimer's disease research centers in nine states, including at the University of Wisconsin, Madison. It has delayed 47 million dollars in cancer center support grants at nine cancer centers in eight states. It has delayed 55 million dollars for 11 rare disease clinical research network grants in eight states. Let that sink in. This administration is making a conscious choice not to fund research into Alzheimer's disease, cancer, and rare diseases. And NIH has terminated grants for maternal morbidity and mortality center, a grant developing new digital imaging techniques for cervical cancer screening, and a clinical trial studying a potential cure for infants born with HIV, just to name a few. Many of us have been sounding the alarm about this for months. Through May of this year, NIH awarded 3,288 fewer grants than through the same time period last year. Now, the administration's own budget clearly shows this is the plan to award thousands of fewer grants this year. Each one of those grants represents a contribution to scientific progress, a potential new cure or treatment, or a medical breakthrough that could save millions of lives. And on top of that, this budget proposes to cut $18 billion or 40% from NIH next year. That should be all the proof we need to judge this administration's intentions and its priorities. This administration says it will ensure the United States remains the global leader in biomedical research, but its actions and a budget request that would cut the number of grants funded by NIH by 15,000 next year clearly shows those are empty words. This administration cannot be left to its own devices. If Congress doesn't intervene, this administration will tear down our biomedical research enterprise, seed our global leadership to China, and rip away cures that families desperately need for reasons I can't begin to comprehend. That's why I will do all I can to work with my colleagues on both sides of the aisle to protect what Congress has built in this country over nearly 100 years that has produced miracle cures, saved millions of lives, and given hope to millions more. So, I look forward to marking up the fiscal year 2026 appropriation bills in the coming weeks, and most importantly, enacting those bills into law later this year to do exactly that. Because this budget request makes it clear that if we don't, this administration will unilaterally enact policies that will be devastating for millions of American families.
Thank you, Senator Baldwin. And now I turn to our witness. We're very happy to have Dr. Jay Bhattacharya, who is the director of the National Institutes of Health. Welcome.
Thank you. Good morning, Chair Capito. Thank you, Ranking Member Baldwin and distinguished members of the committee. I'm Dr. Jay Bhattacharya, director of the National Institute of Health, our nation's biomedical research agency. And thank you for inviting me to testify on the administration's fiscal year 2026 budget request for the NIH. As both Senator Capito and Senator Baldwin have said, the NIH has long been known as the crown jewel of government and science, and for good reason. NIH researchers and NIH-funded scientists across the country have contributed to life-saving breakthroughs in biology, in medicine. Thanks to our work, Americans have improved options to control diabetes, have better treatments for heart disease, better treatments for cancer, and major breakthroughs in sickle cell anemia, and a whole host of other diseases and conditions that I don't have time to list. Because of the NIH, we can reverse overdoses, we can prevent cervical cancers. The NIH's broad portfolio of investigator-initiated research and the agency's essential role in training the future generations of scientists fuels innovation across the country. It is an absolute honor to lead this incredible agency. Despite this progress, life expectancy in the US has flatlined for more than a decade since 2012. Millions of children and adults face poor outcomes due to chronic diseases like heart disease, like diabetes, and conditions like cancer and Alzheimer's continue to have tremendous impact on the lives of millions of Americans. I'm also concerned that after the COVID-19 pandemic, many Americans no longer trust the biomedical enterprise of the NIH. A Pew study in 2024 found that one in four Americans did not believe that the scientists had the best interest of the public at mind. As a scientist myself, I find that tremendously concerning. I applaud the NIH's efforts to advance science during a difficult time. However, I take seriously the concerns of the public and recognize the need for reform at the NIH. So, to restore our reputation among the American people and address the chronic disease crisis, we can't return to business as usual. I join President and Secretary Kennedy in their commitment in advancing 21st century research at the NIH. We will build on the agency's record of solving complex challenges and invest resources where they are needed by prioritizing the health needs of the American people, and I mean every single American. We're working to accelerate innovation at the NIH by integrating recent advances in data science and technology with our growing understanding of human biology. We can fundamentally change how research is conducted. We need to empower our nation's scientists to think big and come up with new ideas that will meet the current and future health needs of the country. Catalyzing this shift to newer technologies is more important than ever as research and health care yield vast quantities of data. As part of the cross-agency initiative, the NIH is leveraging our large-scale data resources to understand the causes of autism spectrum disorder while respecting patient privacy and security of sensitive health data. I look forward to working with the autism community on this effort. To ensure our innovations make an impact, we must mend our relationships with the public. The American people should have confidence in our findings and trust we are working in their best interest. We've implemented a number of reforms to enhance oversight, transparency, and safety at the NIH. Importantly, we're taking action to improve NIH oversight of funding abroad and to improve the safety and security of biological research. I recognize the value of foreign collaborations and know that many critical breakthroughs have been built as a result of highly productive global partnerships. However, I take seriously the fact that our work is powered by public investment and must be accountable to the taxpayer. That's why we're implementing a new policy that ensures foreign institutions receiving money from the NIH face the same rules for payment and data sharing as the domestic grantees. I understand it's a big change for the research community, but it's critically important. Beginning long before the pandemic, the research communities debated whether the government should fund studies that enhance the ability of a pathogen to cause disease or transmit more efficiently among humans. I strongly believe we should not be supporting these kinds of risky experiments, which constitute only a very small fraction of the NIH portfolio. The NIH is actively identifying and ending dangerous gain-of-function research that could threaten public safety. The scientific debate about gain-of-function research demonstrates the importance of academic freedom. Diversity of opinion is essential in driving scientific progress. Interrogating evidence and challenging status quo ensures scientific rigor and meaningful results. That's why I'm working to ensure scientists at the NIH can engage in open academic discourse without risk of official interference. It's also important that we solve the reproducibility crisis in research. Reliable, reproducible, generalizable research must serve as a basis for truth in biomedicine. And unfortunately, many research findings have not been reproducible. This is not a moral failure of individuals, but rather a systemic issue that places too much pressure on publishing only favorable results. We're actively exploring ways to reward scientists for cooperating replication, sharing data, and establishing for application. In closing, I'd like to thank this committee for the generous support of the NIH mission to improve the health and well-being of Americans. I look forward to working with all of you as we chart a path forward for biomedical research to make America healthy again. Thank you, and I look forward to your questions.
Thank you, Doctor. And I'd like to turn to the chair of the committee who are very honored to have with us, Senator Collins.
Thank you very much, Senator Capito. Doctor, let me start by welcoming you to the committee. I am well aware that you have devoted your life to medical research, to health economics, and that you care very deeply about NIH. That is why the administration's reduction of more than 19 billion dollars to the agency's budget, that is approximately 40%, is so disturbing. It would undo years of congressional investment in NIH, and it would delay or stop effective treatments and cures from being developed for diseases like Alzheimer's, cancer, type 1 diabetes. I could go on and on. We also risk falling behind China and other countries that are increasing their investment in biomedical research. Let me give a specific example. There are an estimated 7 million Americans living with Alzheimer's today. Barring any major breakthrough to prevent, slow down, or cure this devastating disease, this number could almost double to claim the lives of more than 13 million Americans by the year 2060. And that's why this committee has been so dedicated to increasing the funding for biomedical research and for Alzheimer's in particular to more than 3 billion last year alone. And it's produced results. We've seen the first two drugs that have been shown, when administered early enough, to slow cognitive decline. We have also seen the development of a breakthrough blood test, which will help lead to earlier diagnosis. Yet the administration's budget proposes a decrease of 40% for the National Institute on Aging, which funds most Alzheimer's research. As a senator representing the oldest state in the nation, this is a particular concern to me. And like Senator Capito, I too lost my father to this devastating disease, as well as my grandfather, two uncles, and just last year a brother-in-law. So, I know personally what it means to so many American families. Why is the administration proposing to cut the funding for the National Institutes of Aging, when we are making progress in treating Alzheimer's and other dementias?
Senator, thank you for the question. So, first let me just say that I am fully committed to making scientific progress in Alzheimer's. I know all too well from my own research work and from friends and family members the devastating toll of this disease. And we have made tremendous progress. The NIH supports a very wide range of hypotheses on Alzheimer's and it's resulted in some advances like for instance the blood test for early detection. We still don't have, I think in my professional opinion, a sufficient way to manage the disease, to prevent the disease and to cure the disease. We need more advances. I am absolutely committed to making sure the NIH plays a tremendous role in that. The President wrote a letter to Michael Kratsios, his science advisor, committing the United States to be the leading nation in the world in biomedicine. And so that's the intention of this administration. The budget, this is my first time through this budget fight and so I'm still learning, but I'll tell you what I understand is that the budget is a collaborative effort between Congress and the administration. I look forward to working with you all to advance the real health needs of not just the folks here in the room who represent Alzheimer's patients, but also health needs of all Americans. We have tremendous health needs that we have to address. It's only excellent research that's going to solve those problems.
We look forward to working with you to remedy these problems and the deficiencies in the budget. Prior to your confirmation, NIH abruptly and without any notice or input from the community announced a 15% arbitrary cap on research-related costs, also called indirect costs, for institutions that receive grants from the NIH. This proposed cap is so poorly conceived, and I've seen firsthand how harmful it is. It is leading to scientists leaving the United States for opportunities in other countries. It's causing clinical trials to be halted and promising medical research to be abandoned. It's also against federal law. Since 2018, we in Congress have specifically included language to prevent NIH from arbitrarily imposing such a cap. During your confirmation hearing, you committed to working with us on this issue. So, I was alarmed and surprised that the administration's budget request contains the same harmful 15% cap. Recently, I met with Dr. Kelvin Droegemeier, who was President Trump's science advisor during the first term. He has come up with two possible models, which are far fairer, make way more sense, increase accountability. Have you had the opportunity to meet with Dr. Droegemeier and look at the models that he has come up with after extensive consultation?
So, I spoke with Dr. Droegemeier before he started the process and he told me about those proposals in the planning stages. I've not yet met with him after because he had a working group that he put together of experts to think about this. I think that they're quite promising. The key thing, first I can't speak about the 15% because it's subject to litigation so I don't want to get into that, but I want to bring the broader policy issue which is how should the federal government support the research institutions of this country where the research we've been talking about takes place. I think it is an opportunity to rethink that. We absolutely have an obligation to make sure that the institutions have the capacity to do the research correctly. Are we doing it fairly? Do we have processes in place that have sufficient geographic representation that scientists across the country wherever they are have access? I think we can do a lot better and I'd love to work with Congress to address that. I think there's lots of great possibilities for reform.
Thank you. I encourage you to sit down with Dr. Droegemeier as soon as you can. Thank you, Madam Chair.
Thank you. Senator Baldwin.
Thank you. As I said in my opening comments, I've been raising the alarm now for months about NIH grant making being significantly behind its normal pace. This year NIH has awarded nearly $3 billion less compared to the same period last year. That's at least 3,288 fewer grants. So, Dr. Bhattacharya, I want to know who is withholding this funding. Is it you? Is it DOD? Is it OMB? Who is making those decisions?
Well, Senator, there's a range of decisions that I think will lead to some of those pauses of grants.
Who is making those decisions? Not what are the decisions, but who is making them? You? DOD, OMB, someone else?
So, that's because there's a range, that's the different answer for some of those.
Okay, so all of the above?
Well, no, not necessarily. It depends on what the specifics we're talking about. So, if I may, there's changes in priorities for the NIH to move away from politicized science, I've made those decisions. Decisions regarding, for instance, Harvard and some other institutions, that's joint with the administration. And those are I believe temporary after settlements are reached with those universities. So those are the primary classes of decisions you're talking about.
Okay. We now have the fiscal year 2026 budget proposal, which shows the plan is to award significantly fewer grants this year and next. OMB Director Vought recently made a major change on the way that NIH will fund grants. And I want to make sure that the committee is really aware of this because it hides an even deeper cut than the 40% that we're talking about. So, for half of its research grants, NIH is going to start forward funding them. In other words, in one year granting a multi-year grant. This is going to have significant impact in the near term on the number of grants NIH awards and how much is spent on research. Your budget requests an $18 billion cut for NIH, and that's bad enough. But to be honest with Congress and the American people, this forward funding scheme means that the cuts are even deeper. It means billions will effectively be put in escrow and won't actually be spent on research for a number of years to come. It means that you're effectively cutting research funding next year by another $7 billion on top of the $18 billion cut you propose. And it means that next year NIH would award a fraction of the grants it has historically. Your budget already proposes to award 15,000 fewer research grants next year. And this change alone, this forward funding, accounts for about 4,000 of those. While I think Congress will reject your budget request, it clearly shows the administration's intent. And you can cut $7 billion and dramatically reduce the number of NIH awards next year on your own, unless Congress steps in to stop that. So, Dr. Bhattacharya, I'm struggling to find a reason why NIH would implement this forward funding policy. How is this proposal anything but intentionally sabotaging biomedical research?
So, Senator, a couple of things. One is regarding funding for this year. Congress allocated the money. My job is to make sure that the money goes to excellent research projects. My intention is that we will spend...
I'm asking about the forward funding proposal that disguises even deeper cuts in the NIH budget than the budget submission would suggest.
Yeah, so I just wanted to preface my answer to that because you asked that also. But as regarding forward funding, that's a budget proposal. I mean, again, the policy administration reduces the amount that will be spent on biomedical research next year by an even deeper amount than the $18 billion 40% cut already.
Right. So the way the forward funding works, right now we have multi-year projects that we fund.
And forward funding says, we will allocate the money for those multi-year projects this year rather than in the out years. And so if it's a 4-year project, three of the years will sit in an escrow account and not be spent next year. Again, further diminishing the amount that will be spent on biomedical research.
No, I think the thing is that in the long run what it does is allow you to spend more money and have more flexibility for new research projects. That's because of the budget math. I mean, it's just the math. I'm an economist also. What it does is it says, 'Look, let's allocate the money this year so that next year the money isn't tied up on previous years' projects.' That's in the long run. I mean, as I said, I'm happy to work with Congress on this. This is a budget proposal, not a final thing. I think if I had to start and redesign the system again from start, allowing more flexibility as new scientific opportunities come up, the forward funding model allows that to happen actually more than the current model where large fractions of the NIH budget are tied up with old projects. So I think that but as the transition in, it really matters how we do it. And so I'm absolutely really glad to work with Congress on that to make sure that there's no disruptions.
Thank you. I'm going to save my Alzheimer's question. I think Senator Collins and I have like opinions on that and very much want to see the innovation in detection, diagnosis, and treatment move forward and hope that as you're setting the priorities and we set them with you, you know that this is a top priority for many of us who are here and me in particular. I want to ask about the idea program. You mentioned about geographic diversity of research. And we know and I think the statistics bear out that only a certain amount of states are getting enormous amounts of funding for research in NIH and some of the middle states and I'm in the middle state. Those of us have difficulty securing research grants and moving forward with it and that's where the idea program really helps. How do you see that when you're looking at the larger picture of priorities? Where do you see the value in that and how do you think we can make sure that those developmental awards are not just still granted but also increased?
All right. So, the ideas program is a tremendously important part of how we support research in states and universities that don't traditionally get a lot of NIH money. I was looking up the numbers. I think it's like 440 million in fiscal year '24 which is really a small fraction of the NIH funding. I think from a point of view of science policy, it's absolutely vital that the NIH investments are geographically dispersed. And the main reason for that is the way we combat scientific group think is by empowering researchers across the country no matter where they are to have a great opportunity if they have great ideas for NIH funding. And the ideas program really makes that happen. In my mind, it's probably less funded than it ought to be and I actively would love to work with Congress to think of ways that we can make the NIH investment in scientific research more geographically dispersed than it currently is. It's very concentrated now with I think 20 universities getting about 60-65% of the money from NIH. The system is set up almost to guarantee that that happens.
Thank you. Well, I look forward to working with you on that. And since we're talking about the different geographies, I have learned in the course that if you have a designated cancer center or a National Cancer Institute in and around where you live, your ability to access treatments, your success rate, your early interventions are so much better. And some states are called emerging cancer institutes. One of those happens to be mine. So, there are 14 states that don't have an NCI-designated cancer center. I guess my question is, since a lot of it is rural and there's a huge monetary commitment, too, for the universities or the state to be able to create a cancer institute, but this is something that I think is amazingly important to rural parts of this country. How would you close that gap for the underrepresentation in the cancer institutes?
It's very, very important that we expand the NCI's investment in states. It should be national. It should be everywhere, right? I think every... And it's really important that we collaborate with universities everywhere to make that happen. That's a major priority of mine. As you say, Senator, there's lots of scientific reasons. Like we want to make sure that the cancer trials that we do represent the entirety of the American population. And the investments that we make in advancing cancer can't happen without our cooperation with you and identification of patients in places we don't traditionally go. I think the NCI has done a really good job in the states that it's in, but we need to do better in expanding the National Cancer Centers to other states. That is a major priority of mine.
Thank you. Another priority on my last few seconds that I have is the research, the funded research that's actually occurred under the opioid and addiction research. I mean this is a growing issue. The statistics have come down but I don't think we should be taking that as a sign that this is not still a tremendous problem across the country. And Dr. Rosai in our state is using a low intensity focused ultrasound to restructure the way that the brain reacts to certain stimuli. And so how does your budget prioritize continued investment in addiction treatment?
Senator, as you know, the statistics are heartbreaking. Since the pandemic, I think the pandemic fueled a rise in drug overdose deaths with almost 100,000 Americans a year dying. And last year there was some reduction down to 80,000 but nowhere near pre-pandemic levels. The NIH has funded big advances for instance in Naloxone which is used to reverse opioid overdoses is in part due to NIH research. I think we have a long way to go. It's absolutely vital that we make investments to address this problem that affects the lives of so many Americans and their families. Medical research is going to be a tremendously important part of the solution going forward. And we still need more advances. How do we prevent it? Medicine may play an important role in that, as well as advances in our understanding of the behavioral circumstances that lead to addiction and much else. So absolutely I'm committed to that.
Thanks a lot Madam Chair and Doctor welcome. 10 years ago I made a visit to the NIH and I met with a man who I believe is an American hero by the name of Francis Collins. He had the job which you currently have. And I asked him what I could do as a member of the Senate to help NIH. In previous years the number of bipartisan efforts that resulted in doubling its budget, I didn't think that was realistic. And he said to me, 'What is realistic and it's hard to do is give us 5% real growth every single year. If you can do that, we're going to light up the scoreboard. We are making breakthroughs in so many different areas. 5% real growth. Our researchers will know they can count on next year being another good year for medical research.' So, I came back here and I talked to Patty Murray, who will join us, I'm sure, before this is over, asked her to join in this effort. Then I reached across the table to Roy Blunt, who was a predecessor as a chair of this committee, and Lamar Alexander and a number of others who are here today and said, 'Let's go for 5%.' You know what we did? In 10 years, we went from 30 billion at NIH to 48 billion. An $18 billion increase in medical research at NIH. I couldn't have been prouder of all of our bipartisan efforts to do that. This year, your budget wipes it out completely. Wipes out $18 billion that we fought for over 10 years. And I can't understand that. I disagree with this administration on so many things, but this is the one that really gets to me personally. To think that this nation would walk away from medical research. For God's sake, we lead the world in medical research. Why would we give up on it? I look at the specifics here. Cancer. 2025, 2 million new cases of cancer will be diagnosed in the United States. 600,000 people will die from that disease. Yet your budget requested 38% cut. 38% to the National Cancer Institute. 7 million people nationwide are living with Alzheimer's. This disease, of course, is devastating to families. It robs them of their loved ones. Yet, your budget requests a 39% cut to the National Institute of Aging. When you look at specific schools, of course, I'm concerned about Illinois. We have great research there. Northwestern University has not received a penny for NIH grants in 11 weeks. 1,359 NIH awards to Northwestern have been frozen or terminated, holding $81 million in research to date. I could go through some of the specificities of this research, but it includes $9 million in clinical trials for brain cancer, colon cancer, breast cancer, childhood cancer. How are you able to reconcile these budget decisions with the reality of research and what it means to alleviate suffering and more importantly, to give people hope? If research is underway, you at least have the hope that maybe there'll be a cure, maybe in the lifetime of someone I love. How can you walk away from that?
Well, listen, it is my intention not to walk away from that. I mean, I think that...
It speaks for itself. You cut $18 billion in research.
Well, Senator, the budget is a collaboration between Congress and the administration. So, you know, I look forward to talking about the advances that NIH research has made. I think the transition has been a very bumpy time. And I don't mean to downplay that, but there have been opportunities for reform for how the biomedical research enterprise works. I think the decisions about Northwestern happened before I got into office, but let me just say that...
The buck stops in your office.
Don't blame another person.
We're asking you and your insurance.
Senator, I agree with that. So, let me just say that I think that the way that the universities operated during the pandemic didn't always make it easy for scientists to do their work. I can tell you that personally from being a professor. And I think some of the...
Eliminating grants, eliminating research, how can that solve the problem?
So, I think that I'm very hopeful that a resolution can be made with the universities where those grants have been paused. I've worked very hard to make sure for instance at Harvard we didn't pause grants to the medical centers because there were clinical trials going on. But I think that I'm very hopeful that the universities where these pauses have happened will come to terms so that we can move forward with the agenda that I think you and I both share.
We absolutely will. Let me say this. I am personally disappointed. You know, you try as a senator to pick one or two areas and really make a difference. And I think this committee and the members of this committee on both sides made a difference, dramatic difference, 60% increase in NIH research over the last 10 years. You've wiped it out. Just wiped it out. And now we start anew. And forget my disappointment, the disappointment of the people sitting behind you who are counting on this research for hope for tomorrow that life will be better for them and their families. Madam Chair, I'd ask consent that a statement from the ALS Association be entered in the record after my statement.
Chairman Capito, thank you very much. Dr., welcome, nice to see you again. Thank you for the conversations that we've had prior to this hearing. Dr., this to perhaps follow on to what Senator Durbin was talking about, the life of a United States Senator I assume has lots of glamour and excitement, but I can tell you that perhaps the most satisfying, I say that with a smile because I'm not certain that it's true, but I can say all in all seriousness, one of the places that I found satisfaction in this job, one of the reasons this job has value to me and hopefully to my constituents, is the work that we do in regard to combating diseases and finding the cures and the treatments for Alzheimer's and cancer and diabetes and the list is ALS, the significant list, and the opportunity then to have a sense of satisfaction that our constituents are actually finding value from what we do. Of probably as all of the arenas in which I work as a United States Senator, this one provides the most satisfaction. And it's one that I can relate to my constituents in which they find satisfaction. There is a lot of skepticism and distrust about government generally, the federal government perhaps in particular, but where there does seem to be satisfaction with what we're doing is in support for finding those cures. And so, what job, what task you've taken on is hugely important to me, hugely important I think to this committee, and hugely important to the country. And how you make decisions now has the opportunity to get the satisfaction that we find, that I find at least, in trying to do the things that make a difference in people's lives, individuals, and to provide that hope that Senator Durbin talked about. If Congress, you say this is a collaborative effort and you're absolutely right and I encourage Congress to exert its authorities and utilize its responsibilities in this arena and many others. So, if Congress were to provide additional dollars above and beyond the president's budget request, how would we as a committee and how would you as NIH recommend for us to prioritize that spending to get what you're looking for as in a bit shaking up past process and system by which grants are awarded and results are attained?
Well, there's a number of ideas that I've had in my Senate hearing before when I was confirmed as well as in other public things. I think first we have to focus on the real health needs of the American people and they are enormous. Alzheimer's, yes. Heart disease, diabetes, cancer, all of these we need to make advances and so many others I don't have time to talk about need focus and need research and need advances. I also have been heartened by the nearby partisan support that the NIH has long enjoyed and I hope that we can get back to that. I view that as part of my job is to say look let's have an agency that focuses on things that really matter to people as it has and I think it continues to do. Second, we have to address some of the real problems in science, right? So, the replication crisis I've mentioned many times. Most people don't know about this, but a lot of scientific research when independent teams look at the same result, they don't find the same answer. That's basic science. You'd expect it, there's reasons why that happens. There's no real advantage to doing replication work. That's something the NIH can fix. When drug developers do their own investments, they tell me that they do their own private replication work because they can't trust the biomedical literature. We can fix that as an NIH and so I'd love to be able to fix that problem. We need to think big. Some of the advances are incremental. Let's focus on thinking big. So I think, again the budget it's a collaborative effort but I think it's going to be important that we address the real problems in science and the real needs of the American people with whatever budget it comes out and that's my job.
Doctor, I think I wrote down what you responded and among all those words you said we need focused research and advances. And I assume that means need more resources. And that you would put them to good use. Is that accurate?
That's my job is to make sure that every dollar goes to real science that really meets the health needs of the American people.
Let me ask one final question. INCLUDE project is a trans-NIH research initiative established in 2017. The program is supporting scientists and universities and research institutes across the country. Including the University of Kansas Medical Center where researchers are studying Alzheimer's in people with Down syndrome. I've always been fascinated by this particular aspect of research that combines two things I care greatly about into one in some ways. As the administration advances efforts to unleash science across multiple NIH institutes and centers, I believe INCLUDE is a model for those objectives. Will you commit to working with me and the committee to ensure increased federal funding for this effort and maintain the status as an NIH-wide initiative?
I think that's a tremendously important focus. I was recently at an event featuring the advances the NIH made in studying Down syndrome patients and the early onset of Alzheimer's is one of the major problems that Down syndrome patients face. So I absolutely am committed to that, Senator.
Meetings necessary for grants to go forward at some of the 14, or at the 35 Alzheimer's disease research centers, have not been held. And so, there is a kind of an interruption of grant funding. So, Senator, since I've been in office about 2 months, I've been working to turn on all the light switches I can find, including getting the committee meetings going. I think we're now caught up, if not it's very close. And we're on track, I think, to support that research.
Well, I really appreciate that and support that. I think you're hearing bipartisan support. Everyone here at this table has friends. Everyone in the audience has friends and family who are affected by Alzheimer's. And certainly it's a terrible way to finish the arc of your life, drifting into a state of malfunction. So, I turn on every light switch you can, as you say you're doing. I certainly appreciate that. I wanted to turn to the role of nurses. It's maybe a particular interest in that my wife is a nurse. So, I hear a lot about the health care system from her point of view and her colleagues' point of view. But, agree that nurses are a key part of our health care system.
Absolutely, yes. And NIH has engaged in research that is related to the role of nurses, including the impact of patient to nurse staffing ratios. That would be an important area of research.
Yes. Yeah, you know, one reason I particularly want to highlight that is what I have witnessed in some of the major health care systems is that as so many baby boom health practitioners are retiring and so many baby boomers need more health care, the pressure becomes for a higher and higher patient to staff ratio, which then produces burnout, which means that more nurses go on call rather than doing a full work week or retire, accentuating the problem. And so, really trying to address the working conditions for nurses is in the interest of keeping more nurses working and therefore have a productive cycle rather than an unproductive cycle. So that research is important. Research also, nurses are engaged in interventions that improve the quality of life for many patients, including cancer survivors. Sometimes doctors are a little more on the engineering side, but in terms of the bedside to bedside and follow-up, nurses play a key role. You'd agree with that?
Yes, I would. I mean, I'd just say personally as a medical student, I learned at least as much from the nurses that I had the privilege to work with as I did from many of the doctors.
So this is why I'm confused about your decision to eliminate your proposal to eliminate the National Institute of Nursing Research, because such important work is done through that institute. And could you give us a little insight on that?
So, I'll just say again, the restructuring decisions are something that are done in collaboration with Congress. I mean, I looked up the history of this and Congress has weighed in many times, and there's a process which I'm committed to following to make that in collaboration with Congress. But the substantive question, how should the research that you've outlined, and wherein should it be done? The key question to me is not the organization of the NIH, but the collaborative nature of the NIH, that research needs to get done because it advances health and well-being of American people. Where exactly it happens is less important to me than that it gets done. I'm committed to making sure that research like that does get supported.
So, essentially what I hear you saying is you put forward a proposal to eliminate the National Institute of Nursing Research, but you understand that restructuring is something that should be done in collaboration with Congress. That actually is the way the Constitution is designed, so I appreciate your making that point, and I'm sure folks here will be very engaged in that conversation. So, in terms of any concern that anyone might have, if Congress funds NIH, decides to fund and the bill is signed by the president, the National Institute of Nursing Research, we don't have to be worried that suddenly those funds will be impounded and it will be shut down.
Senator, a lot of nursing research, including the things you've outlined, are important for advancing the health needs of the American people. Understanding the nursing ratios, for instance, that's something I actually studied earlier in my career. So, I understand why it's such an important question. So, yeah, I absolutely support that research.
But my question was, if Congress funds it by law, we don't have to worry about the administration shutting it down despite the fact that we have funded it by law.
My job is to make sure that the funds that the Congress allocates for the National Institutes of Health are translated into improvements in the research that improves the health and well-being of the American people. I'm going to make sure that that money is spent, whatever you all allocate to me.
Thank you. Senator Kennedy.
Doctor, you don't look like Satan to me.
Some of my colleagues have accused you of everything but abandoning your children to wolves. Do you hate medical research?
I devoted my life to medical research, Senator.
I love the NIH. I think I said that in my Senate hearing in my early Senate hearing. I absolutely think it's the most important biomedical institution in the world.
This budget that we're debating today is the president's budget. When's the last time Congress took a president's budget and enacted it?
You know, the funny thing is, thanks to this process, I've got to meet and talk with all y'all.
When's the last time that happened?
I don't I can't remember.
It's never happened in the history of ever happened.
I mean, everyone has strong opinions about what should happen and Congress gets to have a say, and that's a good thing.
There's some changes that need to be made at the NIH, aren't there?
Okay. If I'm the president of a university and I came to you at the NIH and said I need $10 million to research a cure for nephritis, and I took that $10 million and spent $5 million of it renovating the vice provost's home, that would be morally repugnant, wouldn't it?
If I were a college president and I came to NIH and asked for $20 million to research a cure for dementia, and I took $5 million of that and used it to buy a yacht for my university, that would be morally repugnant, wouldn't it?
That would. And that's not hypothetical, alas.
There's been a lot of talk about the difference between direct costs, spending the money on research and cures for nephritis, and indirect costs, overhead. Harvard, for example, with a $53 billion endowment, spends 69% of its money from NIH on overhead, does it not?
I haven't looked at the latest numbers, but it's definitely in that range.
Yale spends 67.5% on overhead, does it not?
Again, roughly in that range, yes.
So, all this money spent on overhead is money that's not being spent on medical research, is that right?
Well, it's for fixed costs of lab space and things, but also sometimes for other things. So, some of it's absolutely necessary.
Well, if I'm the Gates Foundation and I came to the NIH and said, 'I don't want money. I want to give you money. I want to give you $100 billion. But you can't spend more than 10% on overhead.' Would NIH turn it down?
I wouldn't turn it down, no. In fact, I think the Gates Foundation overhead rates are roughly again in that range, 10 to 15%.
Robert Wood Johnson Foundation limits overhead to 15%, does it not?
That's what I understand, something like that.
Now, I want you to think in terms of the American people and the importance of medical research. What do you think is more important? And we have finite resources. I support giving resources to NIH. I think NIH does breathtakingly innovative work. But if you ask American people, would you rather give money to research cerebrovascular disease or would you rather give $142,000 to the Seattle Children's Hospital to study how to use telehealth to improve access to gender-affirming care? What do you think the American people would say?
Senator, the NIH should be a non-political organization, non-ideological, addressing the health needs of American people.
But yet the NIH also spent $120,000 in a grant to, quote, develop 3D avatars that help people work through gender dysphoria, end quote, did it not?
And the NIH also spent $2,368,492, gave it to Brown University to study, quote, improving mental health among the LGBTQ community impacted by the COVID-19 pandemic, did it not?
I think it did. Although I have to say that we should address the real health needs of Americans, not divide Americans into groups. We have to take into account the real differences in the biology of people, but when we do that, we should do it in a way that really addresses their actual health needs, not...
What I'm running out of time. What we have to do is spend the money on research.
I agree with you, Senator, 100%.
And some universities aren't NIH and NIH is not calling them on it. Isn't it a fact that a study showed between 2017 and 2019, auditors found 137 critical trials funded with taxpayer money involving 41,000 kids and they didn't even report the results? What happened to the money?
