Национальные институты здоровья США: ведущий центр биомедицинских исследований.

US government medical research agency

The National Institutes of Health, commonly referred to as NIH, is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late 1880s and is now part of the United States Department of Health and Human Services. Many NIH facilities are located in Bethesda, Maryland, and other nearby suburbs of the Washington metropolitan area, with other primary facilities in the Research Triangle Park in North Carolina and smaller satellite facilities located around the United States. The NIH conducts its own scientific research through the NIH Intramural Research Program (IRP) and provides major biomedical research funding to non NIH research facilities through its Extramural Research Program. as of 2013, the IRP had 1,200 principal investigators and more than 4,000 postdoctoral fellows in basic, translational, and clinical research, being the largest biomedical research institution in the world, while, as of 2003, the extramural arm provided 28% of biomedical research funding spent annually in the U. S., or about US$26.4 billion. The NIH comprises 27 separate institutes and centers of different biomedical disciplines and is responsible for many scientific accomplishments, including the discovery of fluoride to prevent tooth decay, the use of lithium to manage bipolar disorder, and the creation of vaccines against hepatitis, Haemophilus influenzae (HIB), and human papillomavirus (HPV). In 2019, the NIH was ranked number two in the world, behind Harvard University, for biomedical sciences in the Nature Index, which measured the largest contributors to papers published in a subset of leading journals from 2015 to 2018.

In 1887, a laboratory for the study of bacteria, the Hygienic Laboratory, was established within the Marine Hospital Service, which at the time was expanding its functions beyond the system of Marine Hospitals into quarantine and research programs. It was initially located at the New York Marine Hospital on Staten Island. In 1891, it moved to the top floor of the Butler Building in Washington, D. C. In 1904, it moved again to a new campus at the Old Naval Observatory, which grew to include five major buildings. In 1901, the Division of Scientific Research was formed, which included the Hygienic Laboratory as well as other research offices of the Marine Hospital Service. In 1912, the Marine Hospital Service became the Public Health Service (PHS). In 1938, NIH moved to its current campus in Bethesda, Maryland. When three doctors resigned after refusing to inject patients without their consent, the experiment gained considerable media attention. Funding for the NIH has often been a source of contention in Congress, serving as a proxy for the political currents of the time. In 1992, the NIH encompassed nearly 1 percent of the federal government's operating budget and controlled more than 50 percent of all funding for health research, and 85 percent of all funding for health studies in universities. While government funding for research in other disciplines has been increasing at a rate similar to inflation since the 1970s, research funding for the NIH nearly tripled through the 1990s and early 2000s, but has remained relatively stagnant since then. By the 1990s, the NIH committee focus had shifted to DNA research and launched the Human Genome Project.

Intramural research is primarily conducted at the main campus in Bethesda, Maryland, and Rockville, Maryland, and the surrounding communities. The Bayview Campus in Baltimore, Maryland houses the research programs of the National Institute on Aging, National Institute on Drug Abuse, and National Human Genome Research Institute with nearly 1,000 scientists and support staff. The Frederick National Laboratory in Frederick, MD and the nearby Riverside Research Park, houses many components of the National Cancer Institute, including the Center for Cancer Research, Office of Scientific Operations, Management Operations Support Branch, the division of Cancer Epidemiology and Genetics and the division of Cancer Treatment and Diagnosis. The National Institute of Environmental Health Sciences is located in the Research Triangle region of North Carolina. Other ICs have satellite locations in addition to operations at the main campus. The National Institute of Allergy and Infectious Diseases maintains its Rocky Mountain Labs in Hamilton, Montana, with an emphasis on BSL3 and BSL4 laboratory work. NIDDK operates the Phoenix Epidemiology and Clinical Research Branch in Phoenix, Arizona.

As of 2017, 153 scientists receiving financial support from the NIH have been awarded a Nobel Prize and 195 have been awarded a Lasker Award.

NIH devotes 10% of its funding to research within its own facilities (intramural research), and gives >80% of its funding in research grants to extramural (outside) researchers. Of this extramural funding, a certain percentage (2.8% in 2014) must be granted to small businesses under the SBIR/STTR program. as of 2011, the extramural funding consisted of about 50,000 grants to more than 325,000 researchers at more than 3000 institutions. By 2018, this rate of granting remained reasonably steady, at 47,000 grants to 2,700 organizations.

In 2008 a Congressional mandate called for investigators funded by the NIH to submit an electronic version of their final manuscripts to the National Library of Medicine's research repository, PubMed Central (PMC), no later than 12 months after the official date of publication. The NIH Public Access Policy was the first public access mandate for a U. S. public funding agency.

In 2000, the Joint Economic Committee of Congress reported NIH research, which was funded at $16 billion a year in 2000, that some econometric studies had given a rate of return of 25 to 40 percent per year by reducing the economic cost of illness in the US. It found that of the 21 drugs with the highest therapeutic impact on society introduced between 1965 and 1992, public funding was "instrumental" for 15. As of 2011 NIH supported research helped to discover 153 new FDA approved drugs, vaccines, and new indications for drugs in the 40 years prior. One study found NIH funding aided either directly or indirectly in developing the drugs or drug targets for all of the 210 FDA approved drugs from 2010 to 2016. In 2015, Pierre Azoulay et al. estimated $10 million invested in research generated two to three new patents.

Since its inception, the NIH intramural research program has been a source of many pivotal scientific and medical discoveries. Some of these include:
1908: George W. McCoy's discovery that rodents were a reservoir of bubonic plague. 1911: George W. McCoy, Charles W. Chapin, William B. Wherry, and B. H. Lamb described the previously unknown tularemia. 1924: Roscoe R. Spencer and Ralph R. Parker developed a vaccine against Rocky Mountain spotted fever. 1930: Sanford M. Rosenthal developed a treatment for mercury poisoning used widely before the development of dimercaptoethanol. 1943: Wilton R. Earle pioneered the cell culture process and published a paper describing the production of malignancy in vitro, Katherine K. Sanford developed the first clone from an isolated cancer cell, and Virginia J. Evans devised a medium that supported growth of cells in vitro. 1940s–1950s: Bernard Horecker and colleagues described the pentose phosphate pathway. 1950s: Julius Axelrod discovered a new class of enzymes, cytochrome P450 monooxygenases, a fundamental of drug metabolism. 1950: Earl Stadtman discovered phosphotransacetylose, elucidating the role of acetyl CoA in fatty acid metabolism. 1960s: Discovered the first human slow virus disease, kuru, which is a degenerative, fatal infection of the central nervous system. This discovery of a new mechanism for infectious diseases revolutionized thinking in microbiology and neurology. 1960s: Defined the mechanisms that regulate noradrenaline, one of the most important neurotransmitters in the brain. 1960s: Developed the first licensed rubella vaccine and the first test for rubella antibodies for large scale testing. 1960s: Developed an effective combination drug regimen for Hodgkin's lymphoma. 1960s: Discovery that tooth decay is caused by bacteria. 1970s: Developed the assay for human chorionic gonadotropin that evolved into the home pregnancy tests. 1970s: Described the hormonal cycle involved in menstruation. 1980s: Determined the complete structure of the IgE receptor that is involved in allergic reactions. 1990s: First trial of gene therapy in humans.

In September 2006, the NIH Blueprint for Neuroscience Research started a contract for the NIH Toolbox for the Assessment of Neurological and Behavioral Function to develop a set of state of the art measurement tools to enhance collection of data in large cohort studies. Scientists from more than 100 institutions nationwide contributed. In September 2012, the NIH Toolbox was rolled out to the research community. NIH Toolbox assessments are based, where possible, on Item Response Theory and adapted for testing by computer.

NIH sponsors the Database of Genotypes and Phenotypes (dbGaP), a repository of information produced by studies investigating the interaction of genotype and phenotype. The information includes phenotypes, molecular assay data, analyses and documents. Summary level data is available to the general public whereas the individual level data is accessible to researchers. According to the City Journal NIH denies access to such attributes as intelligence, education and health on the grounds that studying their genetic basis would be stigmatizing.

The NIH partnered with Moderna in 2020 during the COVID 19 pandemic to develop a vaccine. The final phase of testing began on July 27 with up to 30,000 volunteers assigned to one of two groups—one receiving the mRNA 1273 vaccine and the other receiving salt water injections—and continued until there had been approximately 100 cases of COVID 19 among the participants. In 2021, the NIH contributed $4,395,399 towards the Accelerating COVID 19 Therapeutic Interventions and Vaccines (ACTIV) program.

Following the outbreak of the COVID 19 pandemic, NIH funded EcoHealth Alliance has been the subject of controversy and increased scrutiny due to its ties to the Wuhan Institute of Virology (WIV)—which has been at the center of speculation since early 2020 that SARS CoV 2 may have escaped in a lab incident. Under political pressure, the NIH withdrew funding to EcoHealth Alliance in July 2020.

On February 13, 2012, the National Institutes of Health (NIH) announced a new group of individuals assigned to research pain. This committee is composed of researchers from different organizations and will focus to "coordinate pain research activities across the federal government with the goals of stimulating pain research collaboration and providing an important avenue for public involvement" ("Members of new", 2012). With a committee such as this research will not be conducted by each individual organization or person but instead a collaborating group which will increase the information available. With this hopefully more pain management will be available including techniques for those with arthritis. In 2020 Beth Darnall, American scientist and pain psychologist, was appointed as scientific member of the group.

+Historical NIH budgetYearBudget (millions)19380.519400.719452.8195052.7195581.21960399.41965959.219701,061.019752,092.919803,428.919855,149.519907,567.4199511,299.5200017,840.5200528,594.4201031,238.0201530,311.4201632,311.4201734,300.9201837,311.3201939,311.3202041,690.0202142,940.5202245,183.0202347,683.5
To allocate funds, the NIH must first obtain its budget from Congress. This process begins with institute and center (IC) leaders collaborating with scientists to determine the most important and promising research areas within their fields. IC leaders discuss research areas with NIH management who then develops a budget request for continuing projects, new research proposals, and new initiatives from the Director. NIH submits its budget request to the Department of Health and Human Services (HHS), and the HHS considers this request as a portion of its budget. Many adjustments and appeals occur between NIH and HHS before the agency submits NIH's budget request to the Office of Management and Budget (OMB). OMB determines what amounts and research areas are approved for incorporation into the President's final budget. The President then sends NIH's budget request to Congress in February for the next fiscal year's allocations. The House and Senate Appropriations Subcommittees deliberate and by fall, Congress usually appropriates funding. This process takes approximately 18 months before the NIH can allocate any actual funds. When a government shutdown occurs, the NIH continues to treat people who are already enrolled in clinical trials, but does not start any new clinical trials and does not admit new patients who are not already enrolled in a clinical trial, except for the most critically ill, as determined by the NIH Director.

Over the last century, the responsibility to allocate funding has shifted from the OD and Advisory Committee to the individual ICs and Congress increasingly set apart funding for particular causes. In the 1970s, Congress began to earmark funds specifically for cancer research, and in the 1980s there was a significant amount allocated for AIDS/HIV research. In 1992, the NIH encompassed nearly 1 percent of the federal government's operating budget and controlled more than 50 percent of all funding for health research and 85 percent of all funding for health studies in universities. In 1999 Congress increased the NIH's budget by $2.3 billion to $17.2 billion in 2000. In 2009 Congress again increased the NIH budget to $31 billion in 2010.

Researchers at universities or other institutions outside of NIH can apply for research project grants (RPGs) from the NIH. There are numerous funding mechanisms for different project types (e. g., basic research, clinical research, etc.) and career stages (e. g., early career, postdoc fellowships, etc.). The NIH regularly issues "requests for applications" (RFAs), e. g., on specific programmatic priorities or timely medical problems (such as Zika virus research in early 2016). In addition, researchers can apply for "investigator initiated grants" whose subject is determined by the scientist. The total number of applicants has increased substantially, from about 60,000 investigators who had applied during the period from 1999 to 2003 to slightly less than 90,000 in who had applied during the period from 2011 to 2015. Due to this, the "cumulative investigator rate", that is, the likelihood that unique investigators are funded over a 5 year window, has declined from 43% to 31%. In FY 2016, the total number of grant applications received by the NIH was 54,220, with approximately 19% being awarded funding. Institutes have varying funding rates. The National Cancer Institute awarded funding to 12% of applicants, while the National Institute for General Medical Science awarded funding to 30% of applicants. Advisory committee members advise the institute on policy and procedures affecting the external research programs and provide a second level of review for all grant and cooperative agreement applications considered by the Institute for funding.

In 2014, it was announced that the NIH is directing scientists to perform their experiments with both female and male animals, or cells derived from females as well as males if they are studying cell cultures, and that the NIH would take the balance of each study design into consideration when awarding grants. The announcement also stated that this rule would probably not apply when studying sex specific diseases (for example, ovarian or testicular cancer). Taxpayer dollars funding NIH are from the taxpayers, making them the primary beneficiaries of advances in research. Thus, the general public is a key stakeholder in the decisions resulting from the NIH funding policy. However, some in the general public do not feel their interests are being represented, and individuals have formed patient advocacy groups to represent their own interests.

Important stakeholders of the NIH funding policy include researchers and scientists. Extramural researchers differ from intramural researchers in that they are not employed by the NIH but may apply for funding. Throughout the history of the NIH, the amount of funding received has increased, but the proportion to each IC remains relatively constant. The individual ICs then decide who will receive the grant money and how much will be allotted. Policy changes on who receives funding significantly affect researchers. For example, the NIH has recently attempted to approve more first time NIH R01 applicants or the research grant applications of young scientists. To encourage the participation of young scientists, the application process has been shortened and made easier. In addition, first time applicants are being offered more funding for their research grants than those who have received grants in the past.

In 2011 and 2012, the Department of Health and Human Services Office of Inspector General published a series of audit reports revealing that throughout the fiscal years 2000–2010, institutes under the aegis of the NIH did not comply with the time and amount requirements specified in appropriations statutes, in awarding federal contracts to commercial partners, committing the federal government to tens of millions of dollars of expenditure ahead of appropriation of funds from Congress.

The Advanced Research Projects Agency for Health (ARPA H) is an entity formerly within the Office of the United States Secretary of Health and Human Services, which was created by Congress in the Consolidated Appropriations Act, 2022. Modeled after DARPA, HSARPA, IARPA, and ARPA E, it is intended to pursue unconventional research projects through methods not typically used by federal agencies or private sector companies. Secretary Xavier Becerra delegated ARPA H to the NIH on May 24, 2022. It received $1 billion in appropriations in 2022, and $1.5 billion in 2023, and as of 2023 it is requesting $2.5 billion for 2024.