Every couple of weeks I travel to Princeton University to do archival research for a planned biography of the physician-humanist Lewis Thomas (1913-1993). Thomas was president of Memorial Sloan-Kettering Cancer Center, author of “The Lives of a Cell,” and winner of two National Book Awards and a 1989 Lasker Prize, which heralded him as “the poet laureate of 20th Century medicine.”
Working in an historical archive is a lot like laboratory science. Lots of noise and too little signal. You can spend a day plowing through routine correspondence and find nothing of significance just as you can work in a lab waiting for meaningful results. But, if you “turn every page,” as Pulitzer Prize–winning biographer Robert Caro sagely advises, you can strike gold. And sometimes, at least in the Lewis Thomas papers, an archive can become as relevant to science as a laboratory.
So it was when the National Institutes of Health announced that it was going to cut indirect costs to 15%. This sudden pronouncement would cut about 25% of the NIH budget and cripple universities and medical centers, institutions that rely on grant funding to bring innovative therapies to patients, train the next generation of physicians, and to keep the lights on.
Besides funding the full costs of research, indirect costs help to sustain a strong national biomedical infrastructure by enabling research across the country. Nearly 83% of the NIH budget leaves the main campus in Bethesda, Maryland, to fund extramural research. With this support, research is decentralized to all states and many congressional districts, capitalizing on the scientific talent that resides in every sector of the country.
And there has been a tremendous return on investment. The development of mRNA Covid-19 vaccines was made possible by 34 NIH research grants totaling $692 million, according to a report in the British Medical Journal. This research started in the 1980s long before it bore fruit during the pandemic. This is but one of countless examples of research success spawned by NIH support.
My colleagues across the country are shocked and bewildered by these cuts. Careers are at stake, as are the cures and new treatments to which they have devoted their lives.
We are all stunned by the “flooding of the zone.” But when the news of the day becomes too much, history can provide perspective. I have sought refuge in the Lewis Thomas papers. Digging into his archive is like time travel back to midcentury America. It’s a foreign land where Americans still had faith in medicine and science. The marvels of antibiotics and vaccines were still appreciated by those who could remember neighbors who died of bacterial pneumonia or classmates paralyzed by polio. His papers celebrate these triumphs.
The archives are laudatory in part because of Thomas’ elegant prose but also because he came to embody midcentury optimism about medicine and science. After the publication of “The Lives of the Cell”in 1974, Thomas entered the cultural zeitgeist, becoming a beloved national figure. His papers are full of fan mail, everything from students asking for a signed book for a school raffle to curious clergy asking whether he believed in God.
But soon political sentiment changed. Big government was coming under fire. In his first inaugural, President Reagan proclaimed, “Government is not the solution to our problem, government is the problem” — and the NIH was not immune to these attacks. It had to be defended, just as it does now. As Mark Twain reportedly said, “History doesn’t repeat itself, but it often rhymes.”
Thomas’ defense appears in a foreword written for a 1984 history of the NIH. He observed, “We seem to be living through a period (transient, I hope) of public disillusion and discouragement over government and all its works. At all levels, bureaucracy in general is mistrusted, here and abroad. The word is out that government doesn’t really work, can’t get things right, wastes public money, fumbles along, stalls, gets in the way.”
But not so when it came to the NIH. Thomas reminded his readers that the NIH deserved better because it had done so much. He wrote, “At such a time, it lifts the heart to look closely at one institution created by the United States Government which has been achieving, since its outset, one spectacular, stunning success after another. The National Institutes of Health is not only the largest institution for biomedical science on earth, it is one of this nation’s great treasures. As social inventions for human betterment go, this one is a standing proof that, at least once in a while, government possesses the capacity to do something unique, imaginative, useful, and altogether right.”
An agency that took decades to build could be irrevocably damaged in a matter of months, cutting off vital research and decapitating promising careers even before they get started. Patients will be harmed, and lives will be lost. Needed cures and therapies will be delayed or never come to be.
I don’t know what Lewis Thomas would say were he here to witness the dismantling of academic medicine, which he and his “greatest generation” of physicians and scientists helped to create. I suspect he would mourn this loss and remember his house staff days at Boston City Hospital when his colleagues would be sidelined by infections that today would be remedied with a quick course of antibiotics. He often wrote of how far we had come since the pre-antibiotic era and was optimistic about medicine, which he characterized as the youngest science. He might see this turn of events as the folly of academic medicine’s relative youth. But he would keep the faith. No doubt there would be op-eds in which he used the eloquence of his pen to remind society that our complacency is a product of our biomedical success, stressing the importance of the NIH to our everyday lives.
Lewis Thomas was right. The NIH is one of the nation’s great treasures. His lifting of the heart was necessary then. Today, it will take hearts and minds to counter this assault on science. The American people and our representatives must forcefully assert that biomedical research is valued and needs to be properly supported. Anything less is not worthy of the proud legacy of the NIH and a disservice to patients and the health of our country.
Joseph J. Fins is the E. William Davis Jr., M.D., professor of medical ethics, chief of the Division of Medical Ethics, and a professor of medicine at Weill Cornell Medicine and chair of the Hastings Center Board of Trustees. His research has been funded by the NIH. He is at work on a biography of Lewis Thomas.