Biennial Report of the Director

About NIH
Statement of the Director

It is my honor to present to Congress the Biennial Report of the Director of the National Institutes of Health (NIH) for Fiscal Years (FYs) 2010 and 2011. Thanks to the ongoing support of Congress, NIH continues the discovery of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability. NIH has been the driving force behind decades of advances that have improved the health of people across the United States and around the world.

Remarkable Contributions

For 125 years, NIH has been at the forefront of medical research, directing critical funding to research institutions in cities, regions, and states throughout the nation and the world and stimulating lifesaving research breakthroughs. Begun as a one-room Laboratory of Hygiene in 1887, NIH today has grown into a complex and multidisciplinary engine for discovery and innovation, comprising 27 different Institutes and Centers (ICs).

NIH research advances have prompted a revolution in the diagnosis, treatment, and prevention of disease. Thanks to discoveries funded through NIH appropriations, NIH-supported research has met some of our Nation’s biggest health challenges. U.S. life expectancy has increased dramatically over the past century and continues to improve, gaining about one year of longevity every six years since 1990. A baby born today can look forward to an average life span of over 78 years, almost three decades longer than a baby born in 1900.1

We have made impressive gains against cardiovascular disease. In the mid-20th century, cardiovascular disease caused half of U.S. deaths, claiming the lives of many people still in their 50s or 60s.2 Between 1968 and 2008, deaths due to both coronary heart disease and stroke decreased by approximately 75 percent,3 and these mortality rates continue to decline.4 NIH-supported research led to minimally invasive techniques to prevent heart attacks and to highly effective drugs to lower cholesterol, control high blood pressure, and break up artery-clogging blood clots. NIH-funded interventions have also motivated people to make lifestyle changes that promote health, such as eating less fat, exercising more, and quitting smoking. These and other factors have contributed to significant health improvements for Americans. The Centers for Disease Control and Prevention (CDC) reports that the age-adjusted risk of death decreased by over 60 percent from 1935 to 2011, and heart disease and cancer, which accounted for 60 percent of all deaths at their peak in 1983, have dropped to 47 percent in 2011.5

Many chronic conditions begin as part of the aging process. One such disease, osteoporosis, can result in life-threatening bone fractures among older people. NIH-funded research has led to new medications and management strategies for osteoporosis that have reduced the hospitalization rate for hip fractures by 16 percent since 1993 6. Science has also transformed the outlook for people with age-related macular degeneration, a major cause of vision loss among the elderly. Twenty years ago, we could do little to prevent or treat this disorder. Today, because of new treatments and procedures based in part on NIH research, 1.3 million Americans at risk for severe vision loss over the next five years now can receive potentially sight-saving therapies.7

Biomedical research also has benefitted those at the beginning of life. NIH-funded research has given hearing to thousands of children who were born profoundly deaf. Their hearing is made possible with a cochlear implant, an electronic device that mimics the function of cells in the inner ear. The U.S. Food and Drug Administration (FDA) approved cochlear implants for pediatric use in 2000. According to the FDA (as of December 2010), more than 28,400 children in the U.S. have received the devices, enabling many to develop normal language skills and succeed in mainstream classrooms.8

One of NIH’s greatest achievements over the past 30 years has been to lead the global research effort against the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic. Building discovery upon discovery, researchers first achieved fundamental insights about how HIV works, and then went on to develop rapid HIV tests, identify a new class of HIV-fighting drugs, and, ultimately, figure out how to combine those drugs in life-saving ways. A recent study estimated that 14.4 million life-years have been gained among adults around the world since 1995 as a result of AIDS therapies developed through NIH funded research.9 In addition to encouraging progress on an HIV vaccine, NIH has also led groundbreaking research on using HIV therapies to prevent new infections in uninfected individuals at high risk of infection, such that we can now envision an AIDS-Free Generation.

1 National Vital Statistics Reports, Volume 61, Number 6 October 10, 2012. Deaths: Preliminary Data for 2011. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf.
2 Fox, CS, et al. Circulation. 2004;110(5)522–7. PMID: 15262842.
3 NHLBI Morbidity and Mortality: 2012 Chart Book on Cardiovascular, Lung, and Blood Diseases, page 26.

4 National Vital Statistic Reports, Volume 61,Number 4 October 10, 2012. Deaths: Preliminary Data for 2011.
5National Vital Statistics Reports, Voume 61, Number 6, October 10, 2012. Deaths: Preliminary Data for 2011. Available at https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf.
6MMWR. 2006;55(45);1221–4. PMID: 17108890.
7Bressler, NM, et al. Arch Ophthalmol. 2003;121(11):1621–4. PMID: 14609922.
8Francis HW, et al. Arch Otolaryngol Head Neck Surg. 1999;125(5):499–505. PMID: 10326806.
9Mahy M, et al. Sex Transm Infect. 2010;86(Suppl 2):ii67–71. PMID: 21106515.

An Economic Engine

NIH has propelled research advances for the last 60 years by supporting a robust academic community that generates biomedical knowledge, patentable inventions, and trained scientists, including over 130 NIH-funded Nobel Laureates. NIH funding supports research personnel at more than 2,600 institutions that are located in all 50 states, the territories, and more than 90 countries around the world. Investing in NIH not only improves America’s health and strengthens our nation’s biomedical research potential, it propels the U.S. economy. According to United for Medical Research’s report “An Economic Engine: NIH Research, Employment, and the Future of the Medical Innovation Sector,” the $23.7 billion NIH spent extramurally in the U.S. in 2011 directly and indirectly supported 432,092 jobs, enabling 16 states to experience job growth of 10,000 jobs or more, propelling $62.135 billion in new economic activity.10

NIH funding is the foundation for long-term U.S. global competitiveness in industries such as biotechnology, medical devices, and pharmaceutical development. Innovation in biomedical research in a knowledge-based world economy has the demonstrable capacity to generate growth, high-quality jobs, better health, and better quality of life for all Americans. Investments in the biomedical research infrastructure, in scientists’ ideas, and in workforce training spur innovation that will drive America’s future growth.

Unprecedented Opportunities

This is an extraordinarily exciting time to be at NIH as we witness a rapidly accelerating understanding of basic biological mechanisms that will lead to revolutionary new approaches to treat and prevent disease. This understanding is due in large part to technological advances that are changing our approach to science. In the past, most basic science projects in biomedicine required investigators to limit the scope of their studies to some single aspect of cell biology or physiology. The revolution now sweeping the field is the ability to be comprehensive: to define all the genes of a single human, or rapidly uncover all the human proteins and their structures. We need look no further than the cost of deoxyribonucleic acid (DNA) sequencing to see this dynamic at work. The cost curve for sequencing is dropping at a breathtaking rate; sequencing speed has increased even faster than computer processing speed. What’s more, the average fully loaded cost of sequencing an entire genome has fallen from about $61 million a decade ago, to $7 million five years ago, to about $6,500 today. Lower sequencing costs will likely revolutionize how clinicians diagnose and treat diseases and enable the research community to pursue previously unimaginable scientific questions.

NIH is the leading supporter of basic biomedical research in the world. Our investments in basic biomedical and behavioral research make it possible to more accurately characterize the causes of disease onset and progression, design preventive interventions, develop better diagnostic tests, and discover new treatments and cures. From the incremental advances in our understanding of a given disease to the groundbreaking discoveries that revolutionize our approaches for treating or preventing it, investments in basic research have yielded inestimable rewards and benefits to public health. Fostering a broad basic research portfolio is a critical component of fulfilling the NIH mission, and with the pace of discovery brought about by technological advances, we can anticipate an era of ever-expanding understanding of the fundamental mechanisms of life.

Just as important to our mission is the translation of basic biological discoveries into clinical applications that can benefit all. Translational research is a complex process that involves a series of intricate steps. These steps range from the discovery of basic information about the causes of disease; an assessment of whether that information has the potential to lead to a clinical advance; the development and optimization of therapeutics to test in human trials; and, ultimately, the application of the approved therapy, device, or diagnostic in the real world. Drugs exist for only about 250 of the more than 4,400 conditions with defined molecular causes. And it takes far too long and far too much money to get a new drug into our medicine cabinets. This is an old problem that cries out for new and creative solutions.

In the past, drug development was based on a short list of a few hundred targets, but with advances in technology, we are now able to identify thousands of new potential drug targets.11 We can also study whole pathways, organ systems, or even entire organisms rather than limiting the research to a single aspect of cell biology or physiology. Technologies such as large-scale sequencing, robotic high-throughput screening, and real-time imaging modalities uncover massive amounts of data that may one day lead to new therapies to prevent, treat, and cure diseases. But this is not the only way in which technology contributes to this potential revolution in health care. Development of innovative point-of-care technologies is bringing diagnostics and therapeutics to patients’ bedsides while reducing costs.

The need for new approaches to prevention, diagnostics, and therapeutics is great. Despite the progress of the past century, our nation continues to face daunting public health challenges. Chronic burdens placed on our healthcare system through conditions such as obesity, mental disorders, and Alzheimer’s disease demand the innovative, scientifically-based solutions that NIH research derives. In addition to these highly prevalent conditions, there are more than 6,800 rare diseases that affect an estimated 25 to 30 million Americans. NIH is often the only hope for those suffering from these neglected diseases.

We have never witnessed a time of greater promise for advances in medicine than right now. Recent technological advancements have made the current pace of discovery unimaginable only a few years ago. We need to capitalize on this moment and tackle the maladies that afflict millions of Americans and people around the world. And we need to continue to improve our nation’s health. We have achieved much since NIH’s beginning as a one-room laboratory, but we face many scientific challenges ahead. If our nation can exploit today’s unprecedented opportunities in biomedical research across the spectrum from basic science to clinical application, we will be amazed at what tomorrow brings.

—Francis S. Collins, M.D., Ph.D.

10 Ehrlich E (2011). An Economic Engine: NIH Research, Employment and the Future of the Medical Innovation Sector, United for Medical Research. Available at:
http://www.eyeresearch.org/pdf/UMR_Economic%20Engine_042711a.pdf Exit Disclaimer.
11Collins FS. Sci Transl Med. 2011;3(90):90cm17. PMID: 21734173.