Item: On average, an NCI laboratory or branch chief controls more than $4 million per year.
Item: Altogether, eleven NCI intramural laboratories and branches control over $100 million a year, about a quarter of the NCI intramural research budget.
Is NCI putting too much money in the hands of a few scientists? Is there a strategy behind these expenditures? And, finally, would extramural investigators conduct the research more efficiently? These are among the central questions being asked by the National Cancer Advisory Board’s Ad Hoc Working Group on the NCI Intramural Program. In the process of the review, the Institute was directed to produce a breakdown of spending by the intramural branches and laboratories.
Until the working group asked to see the numbers, only top NCI officials had access to this information. Tables summarizing intramural spending in fiscal 1993 were obtained by The Cancer Letter under the Freedom of Information Act.
Interpreting the numbers is anything but straightforward, several observers warned.
For one thing, intramural researchers frequently undertake path-breaking, high-risk (and high-cost) projects. Frequently, NCI faces costs extramural researchers do not, including reimbursement for travel by patients.
Research volume at an NCI lab can be extraordinarily high, too. For instance, one NCI division found that, on average, it spent $75,000 per project, hardly an extravagant sum.
This notwithstanding, several prominent extramural researchers said they were stunned by the budgets of their intramural counterparts.
“They are able to gather for themselves huge amounts of resources unheard of on the outside,” said an executive of a comprehensive cancer center. “When I think of the paucity of funds available to those of us on the outside, it is really disgusting.”
At least one member of the NCAB working group had a similar reaction. “We were kind of shocked when we looked at these figures,” said the member. “Too much money is concentrated in the hands of too few people. When anyone on the outside gets $700,000 or $800,000 for one lab, the committees always want to cut. At NCI, labs with budgets of $2 million to $4 million are common. I think it’s too much. I wouldn’t know where to begin if I had that much money.”
The working group’s report, scheduled to be released next month, is not expected to focus on the budget issues. However, the report is likely to call for revitalization of the intramural program through rigorous budget review and peer review, sources said.
“NCI is a unique place, where you can do unique research,” said a member of the working group. “They should be doing cutting-edge stuff, whether it is clinical or basic.”
More often than not, NCI branches and laboratories defy comparison with extramural research entities.
“We have 12 senior surgeons who are operating on patients,” said Steven Rosenberg, chief of the NCI Surgery Branch, which had a budget of over $ 11 million in FY93 and ranked second on the list of the largest NCI labs and branches.
The branch supports all surgery at the NIH Clinical Center and reimburses patient travel. Also, every senior scientist in the branch runs an independent laboratory. Thus, the branch is comparable to a medical center department, Rosenberg said.
The size of budget should not be the only criterion for comparison between intramural and extramural laboratories, observers said.
Outside NCI, world-class laboratories can have budgets that surpass the $2 million mark.
“If you look at each of the [NCI laboratories or branches] as departments, then the budgets are not so high,” a university-based cancer researcher said to The Cancer Letter. “But if there is one lab chief whose name is on all the papers, and 40 some staff supporting him, then these are huge amounts.”
Comparing NCI to a research-based company is fraught with peril as well. “In the private sector, you can figure per-person cost for R&D of about $100,000 for a small start-up company,” a private sector researcher who has served on NCI Boards of Scientific Counselors said to The Cancer Letter.
“You have clear starting and stopping points, a clearly articulated program with accountability. Unlike the private sector, they aren’t judged by the commercial value of their work.
“At NCI, they don’t seem to be judged by any yardstick.”
Are Lab Budgets Excessive? Views On Intramural Programâ€¨
• Margaret Kripke, chairman of the Dept. of Immunology, M.D. Anderson Cancer Center:
The next NCI director will have to confront the following questions: “What is the mission of the NCI intramural program? How does it compare with the extramural program?”
Without the answers, Kripke said, budget figures are meaningless.
“It is difficult to address the question of whether intramural lab budgets are too high without somebody standing up and saying what is the mission of the intramural program,” Kripke said.
“If NIH is doing the same work as those in the extramural program, then there is little justification for differing budgets. If NIH is where we do the hard, long-term, high-risk stuff, then the funding is not comparable.
“Reducing the intramural program does not guarantee that money will be shifted to the extramural program.
“Under the current budgetary climate, that may be a false expectation,” Kripke said.
• Robert Hoover, chief of the Environmental Epidemiology Branch in the NCI Div. of Cancer Etiology:
“The primary reason our budget is large compared to most laboratory programs is the cost of studying human populations,” said Hoover, whose branch had the highest budget at NCI. “Information and biologic samples need to be collected from thousands of free-living human beings.”
The epidemiology branch, which conducts research to identify causes of cancer in human populations, received $13 million in 1993. Most of the funds supported research contracts.
Hoover said the work of the branch is reviewed in detail, first by the division staff, then by the Board of Scientific Counselors.
“We have a pretty good success rate with the BSC, but there have been projects they didn’t like,” he said. “We would be in tremendous hot water if we didn’t follow the board’s suggestions or follow up on their site visits,” he said.
• Emil J Freireich, director of the Adult Leukemia Research Program at M.D. Anderson Cancer Center:
The Clinical Center is the most unique aspect of the NIH intramural program, Freireich said.
“Some laboratory research can be done anywhere, but the bridging research between laboratory and clinic is really unique at NIH,” he said. “A physician- scientist at NIH can recruit and admit patients for his research, without having to do service work unrelated to the research, and without having to teach. You can’t do that elsewhere.”
Pressure on costs from managed care is threatening clinical research outside NIH, Freireich said.
“If we don’t have NIH for clinical research, we are going to have all the knowledge about biology, but not have a way of putting it to work in sick people,” he said. “I’m personally of the strong opinion that the NIH intramural program needs to be expanded, not cut back. It needs better facilities, it needs to challenge the investigators to work on innovative projects and not do what others are doing.”
• David Berd, professor of medicine at Thomas Jefferson Univ.:
“I don’t know whether the intramural program gets too much funding, but I know intramural scientists don’t get reviewed with the rigor that those of us in the extramural program do,” Berd said.
“Reviews of the intramural program should be taken seriously and the recommendations should be considered mandates,” he said.
By contrast, the chances of winning R01 funding are growing ever more slim. The payline for cancer grants has been 10 to 14 percent for the past several years. In the study section where Berd competes for R01 funds—Experimental Therapeutics 2—the payline is at the 9th percentile.
“With a 9 percent success rate, it hardly seems worth submitting a grant these days,” Berd said. “The drug industry, even with its ups and downs, is looking better and better.”
However Berd, as several investigators interviewed for this story, was reluctant to suggest cuts in the intramural program. “If money is tight, it ought to be taken from cancer center grants, cooperative groups, those kinds of organized grants,” he said.
NCI Intramural Laboratory and Branch Spending for Fiscal 1993
The following list of highest-funded NCI branches and laboratories was compiled from the tables below, obtained from NCI. NCI defines branches as programs, containing clinical research and activities, while laboratories do not include clinical activities.
Abbreviations: DCE-Div. of Cancer Etiology; DCT-Div. of Cancer Treatment; DCBDC-Div. of Cancer Biology, Diagnosis & Centers; BRMP-Biological Response Modifiers Program; FCRDC-Frederick Cancer Research & Development Center.