Impact of National Heart, Lung, and Blood Institute–Supported Cardiovascular Epidemiology Research, 1998 to 2012

In a recent article, Alberts et al1 warned that the US-based biomedical science enterprise is flawed in its assumption that the enterprise will constantly expand, and it cannot expect a persistently expanding National Institutes of Health (NIH) biomedical research budget in the future. In fact, as noted by multiple observers, the NIH budget has been declining in constant dollars since 2003, and the pay lines for grants are at historic lows.1–4 Such realizations have led to calls for a reexamination of the policies and programs of the NIH and its individual institutes and centers.1,2 Some have questioned the appropriateness of the allocation of research budgets between discovery science and translational science.1,2,5 Others have argued for better methods to make funding decisions, suggesting that peer review is too conservative and limits innovation,1,2,4,6,7 or simply does not demonstrate the ability to prioritize research proposals on their potential to yield high impact.8,9 Evidence that scientists spend too much time writing and rewriting grant applications, stay too long in training programs, and achieve their first tenure track position or first NIH grant in their late thirties and early forties, respectively, suggest there is a mismatch in the supply and demand for scientists that must be addressed.1,5,7 Editorial see p 1949 Efforts at the NIH to conduct evaluation and self-examination have already begun. Institutes and centers within the NIH have taken multiple approaches. The National Cancer Institute conducted a workshop to make recommendations on how the National Cancer Institute can transform itself for the 21st century to address criticisms of excess expense, repudiated findings, small incremental gains in knowledge, inability to innovate at reasonable cost, and …