Normally, a perspective piece in a small, two-month old journal would not garner much attention. But, a paper published last week, called “A Blueprint for NIH Reform,” is circulating in academic circles as well as within the National Institutes of Health, as scientists search for hints of where the agency may go in the coming months and years.

The paper has attracted a spotlight because it was written by Martin Kulldorff, a collaborator of the agency’s new director, Jay Bhattacharya, who is also on the editorial board of the publication, called the Journal of the Academy of Public Health.

The blueprint has 12 proposals for the agency, which range from breaking it into pieces to changing the ways researchers are funded to conducting more long-term studies to the creation of a “Covid Commission” to investigate the agency’s handling of the pandemic.  As a whole, the proposal is something of a referendum on the pandemic. 

“I think that NIH failed us during the pandemic, and to restore trust in science, we have to change the way we operate as a scientific community, and have to change the NIH, and I think one key aspect is to be more open and transparent and have open scientific discourse,” Kulldorff said in an interview.  

Experts on science policy who reviewed the paper for STAT said it largely relitigates the NIH’s performance during the pandemic, and is at times correct in its diagnoses of problems at the agency but is biased by Kulldorff’s personal experience. During the pandemic, Kulldorff and Bhattacharya were criticized for writing The Great Barrington Declaration, an open letter they co-authored that challenged the need for most social distancing efforts and called for less stringent public health measures in the first year of the pandemic.

“I think we shouldn’t be Covid-obsessed when we think about NIH reform, and this set of proposals is. It makes sense given who the author is, right? He has an ax to grind, and I don’t blame him for having an ax to grind, but that ends up coloring the tenor of what reform would look like,” said Pierre Azoulay, an economist at the Massachusetts Institute of Technology who has studied the NIH and advocated for reform. 

Several of the proposals line up with policies already put forth by the Trump administration. The paper calls for the same payment rate for indirect research costs for all institutions, a measure that the administration attempted to implement but that has been halted for now by a federal judge. It also emphasizes “academic freedom and open scientific discourse.” In an email to staff on his first day in office, Bhattacharya lists “academic freedom” as one of his top five priorities. 

The paper also proposes basing decisions about making large grants on the applicant’s previous research, as opposed to proposed experiments, and providing training funding directly to universities to disburse, rather than have these awards be judged by an NIH panel. 

The experts who spoke with STAT supported the idea of minimizing the time that researchers spend writing grant proposals and justifying funding. 

“​​Researchers spend way too much time just chasing after money,” said Stuart Buck, the executive director of the Good Science Project, a science policy think tank. “If you look at some of the best places that did research historically, like Bell Labs, scientists had a job, they had funding, it was centrally funded. They didn’t have to spend half their time writing up proposals for why they deserved money and deserve to get a salary and deserve to have a little lab space and so forth.” 

But making NIH funding dependent on a researcher’s previous “first-author” publications, as Kullfdorff proposed, could also create inequities in who can apply for those funds. This approach is similar to how the Howard Hughes Medical Institute, which attempts to fund bold and innovative research, makes funding decisions. But, there are also biases in who is funded by the HHMI, the largest private funder of biomedical research, the experts said. 

“The best predictor of whether you get a Hughes position is whether you work in the lab of somebody else who had a Hughes position, or whether you work in the lab of somebody who is in the National Academy of Sciences. So there’s a huge bias toward the in crowd,” said Jeremy Berg, an associate dean and professor at the University of Pittsburgh who previously led the National Institute of General Medical Sciences at NIH. 

Berg and others noted that in areas they agreed with the proposal, like requiring projects with NIH funding to have open data, or requiring publication in journals with open peer-review, there was little reference to previously published research that examined the pros and cons of similar reform ideas. “It’s relatively easy to pose the problem, and say, ‘We just need to do this.’ Then when you actually try to think about how you would do that, it turns out that it’s flawed, and leads to all kinds of unintended consequences, and is basically unworkable,” Berg said. 

In particular, some outside experts were concerned about proposals that could signal retribution toward the NIH and others that disagreed with Bhattacharya and Kulldorff during the pandemic. In writing about academic freedom, Kulldorff writes that individuals should not be discriminated against on factors including vaccination history, ethical convictions, and political beliefs. That section ends by saying, “Digressions during the pandemic should be rectified.” 

“This looks like it was a setup to punish organizations, institutions and individuals that did things during the pandemic that they don’t like,” said Keith Yamamoto, vice chancellor of science policy and strategy at the University of California, San Francisco, who recently led a group who wrote a report on optimizing the NIH. “I worry that this is a call for retribution for people who didn’t agree with what Bhattacharya wanted to do to open up society during the pandemic.” 

Berg said former colleagues at the NIH have been passing around the blueprint, to understand what changes might be coming to the agency. When asked if he had discussed the paper with Bhattacharya, Kulldorff responded, “you have to ask him what he thinks about these proposals.”

A spokesperson for Bhattacharya and the NIH did not respond to a request for comment.

But, given Bhattacharya’s connections to Killdorff and the journal, researchers have continued speculating. 

“If you told me this is what’s getting implemented, I’d be very worried. I think that they’re not, in their current form, particularly helpful,” Azoulay said. “Of course, everyone who reads this is wondering, ‘Is this what Jay thinks? If that’s the case, then we worry.”