Office of the President

Presented at Temple University School of Medicine

Let me begin by congratulating President Ann Weaver Hart, Dean of Medicine John Daly, those alumni, former patients, and others who gave generously, and everyone who worked over the last half decade to make this stunning new structure possible. At the risk of beginning on a note that could be interpreted as sour grapes, this building does not remind me in the slightest of the Kresge and Medical Research Building Labs in which I labored over 30 years ago!

While this is surely a great day for the faculty, students, staff, and alumni of Temple University, it is also a great day for everyone who will ultimately benefit from the skills and care of the medical practitioners who will be educated in this building and from the biomedical research that will advance our understanding of human health. But the public is not simply a beneficiary of biomedical research and instruction. It is also a major benefactor whose tax dollars played and will play a critical role in both the construction of this building and in the work pursued here. So in a very practical sense, this beautiful new structure represents a social contract between the people of the United States and Temple University School of Medicine.

It is the future of that important social contract between institutions of higher learning and the federal government that I wish to discuss with you today. And because this celebration is occurring at a medical school, my focus will be on the National Institutes of Health, on which so much of biomedical research has depended for the last 60 years. In 2008 alone, the NIH made close to 41,000 extramural awards worth some $16.1 billion to American higher education, mostly in the form of research grants.

Why the emphasis on American higher education? Because universities, as you know well, are the research engines of this country, a role they have successfully filled since the Truman administration, when the decision was made to make them the primary locus of investments in fundamental research and to couple these investments with the education of medical and graduate students – the scientists of tomorrow.

The results of this partnership have been, to say the least, impressive, for American science is the envy of the world. In the medical field, federally funded research has dramatically increased our knowledge of the human body and the diseases that afflict it, so much so that life expectancy at birth is 30 years longer today than it was in 1900. While many changes in our standard of living share the credit for this achievement, including improvements in sanitation and clean drinking water, there is no question that the arrival of vaccines and other preventative measures, antibiotics, new surgical practices, and innovative technologies have had a profound effect on both the length and quality of life of the U.S. population. No fewer than 125 Nobel laureates have been supported by the NIH, which Pennsylvania's Senator Arlen Specter has rightly described as the "crown jewel" of the federal government. Just this year alone, all three of the laureates in physiology or medicine, Elizabeth Blackburn, Carol Greider, and Jack Szostak, are current or former NIH grantees, as are Tom Steitz and Venki Ramakrishnan, who shared this year's prize in chemistry for their beautiful work on the structure of the ribosome.

Yet for all its success, the partnership between the federal government and higher education has an Achilles' heel that is painfully apparent to university administrators and scientists alike. Scientific research cannot be conducted effectively in fits and starts. It needs a long horizon and the assurance of continuous support as it unfolds. In his seminal report to President Harry Truman, Vannevar Bush, director of the Office of Scientific Research and Development, listed five fundamental principles that should guide the government's involvement in the country's scientific enterprise, and the first of them was this: "Whatever the extent of support may be, there must be stability of funds over a period of years so that long-range programs may be undertaken."

Unfortunately, federal funding has been anything but stable, especially in the past decade, and at both an institutional and individual level, the consequences have been damaging to the overall enterprise. Indeed, I am concerned that unless we take steps to break this cycle of boom and bust, our country's global scientific leadership will be jeopardized and the opportunities that I and many of you enjoyed in our careers will increasingly be lost to young Americans.

To illustrate what I mean by the boom and bust cycle, it is instructive to consider what has happened to the annualized growth rate in the NIH budget from 1971 to 2005. As you can readily see, the budget has never had a sustained period of stability, but has been in what biochemists call a futile cycle of growth and retrenchment over the past 35 years. This whipsaw effect, which is a direct consequence of the political budget process in Washington, means that careful and effective planning that permits the wise allocation of resources is virtually impossible. Scientific priorities that need years to nurture are initiated and then suddenly caught without essential support. Universities fall victim to the mixed signals, too. During the boom years, universities respond to the increased demand for research by building new facilities, such as the one we are celebrating today, and hiring new faculty, only to find that those new faculty cannot attract funding when the tide turns, as it inevitably does. This cycle has particularly corrosive effects on young investigators – or as I will indicate in the next section, the not-so-young investigators – who have the misfortune to enter the grant system at one of the downturns in funding.

The last decade has provided us with a particularly poignant example of this phenomenon. Between 1998 and 2003, Congress doubled the budget of the NIH, surpassing the expectations of even the most ardent advocates of biomedical research. "I've been on a high all day," declared the head of the Federation of American Societies for Experimental Biology (or FASEB) as he celebrated a 14.7 percent boost in NIH funding in the fall of 1998 – a high that infected many scientists in this era of "irrational exuberance," to borrow a phrase from Alan Greenspan. Universities and other recipients of federal dollars expanded their research facilities, while faculty recruited additional graduate students and postdoctoral fellows to keep up with the influx of new funds. The American Association of Medical Colleges, for example, estimated that some $15 billion was devoted to new research facilities between 1998 and 2007, in stark contrast to the $3.2 billion that had been expended between 1990 and 1997.

The good times ended abruptly in 2004, when Congress began to tighten its purse strings to the point that the NIH's budget could no longer even keep pace with inflation. The pool of funds available for competing grants – the gateway for both new research and young scientists – was especially hard hit, falling from $2.4 to $2.1 billion between 2003 and 2006, a decline of more than 11 percent, even without adjusting for inflation. Not surprisingly, the number of competing grants awarded also fell, in this case by an alarming 19 percent. As The New England Journal of Medicine put it, "the nation's biomedical research enterprise has never experienced a recession of this magnitude or duration."

The American Recovery and Reinvestment Act enacted last winter brought $10.4 billion of relief to the NIH but it contains within itself the makings of another bust. The infusion of new funds has unleashed a flood of grant applications, stretching the peer-review system to the breaking point and once more raising the prospect of an unsustainable expansion of activity followed by a sharp contraction. Looking ahead to the NIH's budget for 2011, FASEB warns that without a greatly increased annual appropriation, the loss of stimulus funds would decrease the agency's spending power by 13.6 percent in current dollars and 16.4 percent in constant dollars. This is a guaranteed train wreck about to happen.

What would I have done differently with the stimulus funds? Well, if I had been Queen for a Day at the NIH, I would have invested the vast majority of the funds in two things that would have created jobs and manifestly improved the scientific enterprise without incurring out-year costs that we would not realistically be able to meet. First, I would have made a substantial investment in the one-time costs of modernizing existing laboratories and upgrading instrumentation – two areas which would unquestionably create jobs, although not in our own institutions. These are also areas where it has become increasingly difficult to acquire either state or federal funds, and which consequently have increasingly fallen on the universities and research institutes themselves to support. I note that the NIH is proposing to spend only $1.16 billion on these categories, about 10 percent of its total stimulus funds, which I believe is truly a missed opportunity to make long overdue and critical improvements to the scientific infrastructure of the country.

Second, I would have provided funds to tide over the postdoctoral fellows whose job prospects are greatly diminished by the recession. Two-year extensions of fellowships would give them time to ride out the storm and be competitive when positions in academia, government, and industry open up again. Moreover, such a strategy would do less harm to the chances of the current crop of senior graduate students who will be seeking postdoctoral positions in the next few years.

This boom and bust rollercoaster is enormously challenging to an enterprise like life sciences. The research performed in this building and in laboratories across the country can be likened to a majestic ocean liner – slow to get underway and slow to stop. It takes time to plan the strategy, assemble and train the staff, and acquire the tools and facilities that result in new discoveries, and once begun, research cannot be suddenly reconstituted or suspended with impunity. There are those who argue, to echo Rahm Emanuel's "a crisis is a terrible thing to waste," that occasional belt-tightening is good for the scientific enterprise, as it tends to "refresh" the system by forcing the elimination of its least productive investigators. All of us at universities that are in the midst of cutting costs to adapt to the "new normal" recognize that some of our budget savings have come from eliminating things we could do without. Yet, on balance, I would argue that the recurring cycles of boom and bust in science have left in their wake real damage to the enterprise.

Individuals suffer, too, and none more so than the young – from prospective graduate students to newly appointed assistant professors – whose future prospects are heavily dependent on obtaining research grants. In 2008, a group of universities and research institutions from across the country, including Harvard, Duke, and UCLA, issued a sobering report entitled A Broken Pipeline? in which they warned that the NIH's five-year drought was placing an entire generation of scientific activity at risk. "Junior researchers," the authors noted, "are getting a smaller piece of the NIH funding pie. In 1990, they received 29 percent of R01 grants, but in 2007, they received 25 percent of R01s. Further, while the success rate has dropped for all R01 applicants, it is particularly low – only 18 percent – for first-time applicants."

The most recent cycle of boom and bust, of overheated demand followed by overabundant supply, has exacerbated a problem that has concerned me for many years. I call it the LaGuardia effect, wherein postdoctoral fellows are compelled to circle endlessly until they land their first job and then circle once again until they win their first research grant and can begin to build a research program of their own. In what could be called the graying of American science, the average age at which a scientist secures his or her first R01 grant has climbed from 39 in 1990 to 43 in 2007, and many gifted young men and women are simply not prepared to wait this long. Completion times for doctorates and postdoctoral fellowships are also lengthening, with the median time required for the former increasing from six years to eight between 1970 and 1995. In the words of Elias Zerhouni, former head of the NIH, "Without effective national policies to recruit young scientists to the field, and support their research over the long term, in 10 to 15 years, we'll have more scientists older than 65 than those younger than 35." Already, he noted, the NIH "funds significantly more people over the age of 70 than under the age of 30."

The prospect of securing a tenure-track position at an American university in a timely fashion is becoming increasingly daunting, which partially explains the elongation of doctoral and post-doctoral studies. Data gathered by FASEB indicates that while for two decades the number of life scientists employed in tenured or tenure-track positions has held steady, the number of Ph.D.s awarded in this field has doubled, which means that the proportion of postdoctoral fellows reaching such positions has dropped from almost 45 percent in 2001 to under 30 percent in 2007. This over-production of Ph.D.s is a problem that has been documented over and over again by national committees at the National Research Council, including one I chaired in 1998, but our field has yet to properly confront the long-term impact of overproduction. This failure is in stark contrast to American physicists, who successfully curbed their own numbers in the early 1990s, and it threatens to distort – and ultimately undermine – the postwar compact between federally sponsored research and graduate education.

Pursuing a scientific career has never been a cakewalk, but as more and more time is spent in ever-lengthening preparation with only a distant prospect of scientific independence, many undergraduates are beginning to think twice about investing the best years of their lives in the skies above LaGuardia. As Nancy Andrews, dean of the medical school at Duke University, wryly observed, "What a strange business this is: We stay in school forever. We have to battle the system with only a one in eight or one in ten chance of getting funded. We give up making a living until our forties. And we do it because we want to help the world. What kind of crazy person would go for that?"

This brings me to a third negative effect of the boom and bust phenomenon, at least from a societal point of view. American security and prosperity are intimately linked to the work of scientists and engineers, whose discoveries and inventions have transformed the way we lead our lives. As Norman Augustine reminds us in his recent sequel to Rising Above the Gathering Storm: Energizing and Employing America for a Brighter Economic Future, "some economists estimate that about half the nation's growth in gross domestic product per capita during the last half-century can be attributed to scientific and engineering achievements." But today we are a net importer of "high-technology" products. And this country's share of doctorates in science and engineering produced throughout the world fell from 52 percent in 1986 to 22 percent in 2003. Nor can this be airily dismissed as simply a product of Asia's success in educating scientists and engineers. Fewer and fewer Americans are entering these fields, and to the extent that we prolong the path to professional success through erratic federal funding of basic research, we are only making matters worse.

"So what?" one might ask. "There are plenty of foreign nationals to take their place, and science knows no borders." While this is true – and I am an example of an immigrant to the United States who benefited from the opportunity to pursue graduate studies in this country, and then stayed and prospered – it may not always be so. We need to ask ourselves if it is healthy for any country to see the number of foreign-born Ph.D.s in science and engineering under the age of 45 surpass 50 percent of a workforce that is crucial to its long-term welfare. The United States has always been a Mecca for would-be scientists and engineers from overseas, including those in the life sciences, in part because however hard the slog, the rewards and opportunities we offer are greater than any to be found at home. But as China, India, and other countries dramatically expand their research and development activities and increasingly attract investors from abroad, fewer talented young men and women will be tempted to come to this country and, if they do come, stay.

Finally, I would argue that the kind of science we conduct is adversely affected by the sudden appearance and disappearance of federal dollars. When money suddenly dries up, the mindset of applicants and reviewers grows more cautious, to the detriment of risky but potentially transformative research, as well as to young investigators without a well-established record of achievement. To quote the authors of A Broken Pipeline?, "There has been a fundamental narrowing of the scientific vision, with the primary scientific query shifting from 'what is possible?' to 'what is fundable?'" This is profoundly damaging to scientific progress, which depends on daring leaps as well as incremental steps to achieve its goals.

So, if you agree with me that boom and bust cycles are damaging to the biomedical science enterprise, what is the alternative? In the simplest terms, I would argue for a national commitment to stable multi-year funding that guarantees at the very minimum the preservation of spending power from year to year, and is responsive to national needs – for example, an emerging epidemic such as HIV-AIDS or a compelling new scientific opportunity such as sequencing the human genome. The major obstacle that stands in the way of such a policy is clearly the federal government's annual appropriation process. Our bicameral system of government, with power divided between the executive and legislative branches and, then, further divided among powerful congressional committees, in no way lends itself to orderly fiscal management. Finding agreement – any kind of agreement – is a Herculean task that involves more short-term political maneuvering than long-term public policy formation. To quote Daniel Sarewitz, director of the Consortium for Science, Policy and Outcomes at Arizona State University, "the Balkanization of influence over S & T budgeting in the federal government precludes any strategic approach to priority setting and funding allocations. ... From this perspective, it can reasonably be asserted that there is no such thing as science policy in the United States."

But the annual appropriation process is not by any means the only obstacle to a coherent approach to science funding. I worry that the scientific community itself must bear some responsibility for the boom and bust cycles by our perennial insistence that NIH funding must increase each year at rates that are simply unsustainable over even the short term. It is a common refrain to hear presidents of national organizations and professional societies in Washington calling for annual growth rates of 8-10 percent in the NIH budget at a time when biomedical research and development price inflation is well below that figure. In periods of fiscal constraint such as the time we are living through right now, such calls seems questionable at best, and delusional at worst.

I also worry that the expectation that the biomedical enterprise will continue to grow at a rate that outstrips the growth in the federal budget or the economy may come to be interpreted by policymakers in Washington as a failure on our part to set priorities and make difficult trade-offs between continuing work that is no longer having an impact and supporting new programs with greater promise. The life sciences would do well to take a leaf from the playbook of astrophysicists, who have evolved a highly successful decadal process under the auspices of the National Research Council that allows them, in the words of one astronomer, to "lay out the community's research goals for the next decade, identify key questions that need to be answered, and propose new facilities with which to conduct this fundamental research." This is a response to the astronomical cost – no pun intended – of many experiments – from planetary exploration to large-scale surveys of the cosmos – but it also reflects a willingness on the part of the astrophysics community to make its own hard choices. Washington's priorities can and do conflict with those of astrophysicists, as in the former's fixation with manned space exploration, but at least there is a cohesive scientific vision to confront those shaped by political imperatives. Of course, astrophysics is a much smaller and more focused scientific community than the biomedical sciences, which greatly enhances the chances of reaching consensus about priorities for the next decade. And no one understands better than a university president that it is much easier to start something new than to conclude something that is no longer vital. Several summers into my term as president, I led a review of all the centers, programs, and institutes at Princeton, and discovered that there were an embarrassing number about which no one could say precisely what they were doing, or who was doing it. It was a sobering, if somewhat hilarious, moment.

I can see no way around the facts that federal dollars are finite and the general public is not prepared to finance everything. It is a concept that all of us can grasp abstractly, but when it comes to our own research, we seem to forget this truth and push for federal funding as if it were our birthright. We need to step back and, hand in hand with our efforts to educate legislators and their constituents about the importance of sustained support for scientific research, make difficult but necessary choices as to what, at a macro level, is worthy of support. Just because we have done something for a long time does not mean we should continue to do it; just because we can do something does not mean we should.

So I leave you with the following question: if you could change the trajectory of the last 10 years, would you choose to rerun the reel of boom and bust, or would you opt to arrive at the same outcome in 2009, but through steady and predictable increases in federal support for the biomedical sciences? I asked a similar question recently of Alejandro Foxley, the economist and former finance minister of Chile, who is credited with his country's economic recovery following the end of the Pinochet regime. He told me that prior to the crash of the global financial markets, economists in Chile looked to Spain and Ireland as two countries whose economic policies they most wanted Chile to emulate. Today, of course, those same two countries that were flying so close to the sun and enjoying double digit growth in their economies have suffered the hardest falls back to earth, with the highest unemployment rates in the European Union. So my question to Foxley was: "Knowing what you know now, would you still wish Chile to emulate Spain and Ireland?" His answer was yes – he concluded that the enormous benefit of rapid growth outweighed the damage that comes when growth declines. Of course, he answered the question last January, well before the extent of the decline in Spain and Ireland was fully appreciated. For those of us in biomedical sciences, the issue comes down to weighing the real value of the bird in the hand – the rapid doubling of the NIH budget – against the uncertainty of whether the budget would increase at a more measured but steady pace if scientists were not loudly and compellingly lobbying for much larger increases. I pose this question, not because I think it has an obvious answer, but because I don't think we have been asking it in recent years.

Of course, all of you gathered for this celebration know why this question is an important one for us to be asking at this time. In the second half of the 20th century, America created the most impressive and powerful engines for innovation and creativity that the world has ever known. The ingredients of that success are still with us, slightly battered but unbowed. This nation always encouraged a competitive and entrepreneurial spirit that is so critical to scientific progress; it always bet on the young by giving them their independence and freedom to explore relatively early in their careers; it welcomed foreigners to study in our great universities, many of whom stayed and contributed to America's prosperity; it rewarded the best ideas through a merit-based peer-review process; and through investments in fundamental research, America took the long view. My concern about the impact of the boom and bust cycles comes from a fundamental belief in the power of science to improve lives and to promote prosperity for all, and a conviction that as long as we continue to be thoughtful about our scientific enterprise and protect the qualities that made it such a source of economic growth and prosperity, we will prevail.

And if this happens, as I believe it will, the golden age of American science will not be something that my generation talks about nostalgically. Rather, we and the bright-eyed students who throng these halls will be able to say – and say with confidence – "The best is still to come!"