From the Lab to Congress: A Lawmaker Wages a Solo Fight to Shake Up the NIH
WASHINGTON — The “telephone” town hall began as most do.
There was an early question from a constituent about the financial solvency of Social Security, another about the recent passage of a bill to repeal the Affordable Care Act, then a pointed query as to why the telephone town hall was a telephone town hall and not an in-person one.
In his responses, Rep. Andy Harris, sitting in an office that at first glance looked almost too ordinarily Republican — a carved wooden elephant, a metallic elephant, a pair of glass elephants painted in stars and stripes, and a portrait of Ronald Reagan — nearly fell into a script that this year has become familiar for members of Congress.
But then another voice crackled through an aide’s speakerphone.
“I’m 28 years old, I’m a stage 4 colon cancer patient, and I am being treated at Johns Hopkins,” a woman said. “I read recently that … you are in favor of NIH cuts to institutions that use NIH funds for operational costs, or indirect costs.”
How, she asked, could Hopkins researchers afford to keep the lights on if many of their overhead expenditures were no longer funded by the NIH?
Harris, a fourth-term congressman from Maryland, wished her well in her treatment, then dove into a question he felt uniquely qualified to answer.
“We need to look at indirect costs,” Harris replied, “because we could probably fund 6,000 more research projects if we just brought the indirect costs paid by the federal taxpayer down to the levels that are paid by, you know, the Bill and Melinda Gates Foundation.”
Harris is without question deeply knowledgeable on NIH issues. He is a former Johns Hopkins research physician whose work the agency funded for a decade. One study, on the “cerebrovascular effects of intravenous dopamine infusions in fetal sheep,” is published in the Journal of Applied Physiology. He has also kept a close eye on the federal government’s research arm.
But in the months following President Trump’s inauguration, he has pursued what is perhaps an unexpected mission given his background: changing the way the NIH spends its money.
Harris has proven to be one of the White House’s few outspoken allies in its fight to shake up the agency, though even he differs from the White House in terms of an endgame. Both want to slash NIH payments for indirect expenses, which many scientists and university administrators say could irreparably damage their broader research funding framework.
But while the White House wants to fund the same amount of research with less money — Trump’s budget outline in May included “an indirect cost rate for NIH grants that will be capped at 10 percent of total research” — Harris wants to maintain the agency’s overall budget and use the savings to fund thousands more research projects.
“I was a physician scientist,” Harris said in an interview with STAT. “That was my background. I was an academic physician, did both clinical and basic science research — so I think there’s a role for the federal government and a role for the United States in biomedical research. I want to get that right.”
In Congress, however, his is largely a solo fight. Harris was the only lawmaker to side with Health and Human Services Secretary Tom Price on the issue of indirect costs during a March budget hearing, when Price used the issue to justify a proposed $5.8 billion cut to the agency in 2018. Last year, the NIH awarded $6.4 billion for indirect costs at research institutions.
He has also voiced skepticism on how the NIH spends its money generally, lamenting that too little is used directly to fund research projects. When the White House first proposed the cut to the 2018 budget, Democrats cried foul. Republicans, by and large, were quieter but no less resolute in their opposition, and shot down an additional request to cut $1.2 billion from the agency’s 2017 spending.
But when the House’s appropriations health subcommittee invited NIH Director Francis Collins to testify last month, it was only Harris who took an adversarial tone with Collins.
“It sounds like there’s a different standard for the American taxpayer,” he said to Collins at one point.
Together, Harris and Price have driven the NIH funding conversation as the 2018 budget process continues to play out, and the congressman could be helpful to the administration on other issues. Their comments on research funding paint a picture of what the agency could look like in the future with Harris at the helm, thought to be a possibility in January as Trump mulled whether to keep Collins.
Harris has filed a bill that would prevent universities that have declared themselves “sanctuary campuses,” pledging non-cooperation with federal immigration law enforcement, from receiving federal funds for indirect research costs.
And while he did not sign on a recent letter from 41 anti-abortion Republican colleagues asking the president not to re-appoint Collins because his views regarding embryonic stem cell research and human cloning “are not life-affirming,” Harris was quickly able to rattle off a list of, in his view, moral trouble spots inside the agency.
“There are several issues, potentially, that could cross ethical boundaries at the NIH,” Harris said. “The ‘three-parent embryos,’ though that’s mostly the FDA; the human-animal chimera experiments; there’s embryonic stem cell research; there’s research using fetal tissue.”
Harris suggested that such research should be funded exclusively by non-federal sources. But he doesn’t think states should step in to fund research for which there is no ethical consensus. In 2005, in fact, Harris worked in the Maryland legislature to unite Republicans and some conservative Democrats in a filibuster over state funding for embryonic stem cell research. “For states to delve into this is very much beyond the role of state government,” he told the Washington Post then.
He also wrote in January that a House investigation had uncovered “shameful practices” with regard to, among other topics, the NIH’s procurement of fetal tissue for research. “Laws were being skirted,” Harris said, adding that he had brought up his concerns with Collins directly.
Harris was previously seen as a candidate to lead the NIH, and in the interview with STAT, he said “if the president thinks I can help him, I’d be more than willing to discuss that at an appropriate time.”
But with Tuesday’s news that Collins will remain in office, the conversation about a potential NIH leadership role became one for the future. Harris for now seems content to make the 60-mile Capitol commute from his home in Cockeysville, Md., each day Congress is in session, and to continue practicing medicine — he is an anesthesiologist with a subspecialty in obstetrics — at Easton Memorial Hospital in Maryland, just often enough to keep his medical license.
That’s not to say that in his current role he won’t tout his unique expertise.
While some colleagues have found Harris willing to collaborate on controversial legislation, some Democrats say they have found it difficult to work with Harris even on a committee whose debates are largely amicable.
On some issues, there has been bipartisan cooperation. Harris and Rep. Earl Blumenauer of Oregon, a Democrat, later this year plan to reintroduce a bill to streamline the Justice Department’s approval process for researchers hoping to work with marijuana to measure its efficacy as a treatment for some medical conditions. Blumenauer, a proponent of relaxing marijuana laws, and Harris, who has largely opposed medical marijuana use, are likely expecting different research outcomes. But Harris said he is open to either verdict, so long as it’s based on new, scientifically gathered data.
A belief in evidence-based policymaking, however, may be in the eye of the beholder. Harris, during the town hall, joined the growing chorus of GOP voices that have questioned the value of projections published by the nonpartisan Congressional Budget Office, long viewed as an objective body that helps legislators evaluate their own work. But especially with regard to its projections for the recently passed American Health Care Act, Harris has become disillusioned.
“You must have more faith in the CBO than I did,” he said in response to one question, “because the CBO underestimated by at least 50 percent the number of people, when it scored the initial Affordable Care Act, who would be on [its exchanges]. It underestimated the cost of the initial act.”
At the same time, Harris said, “the CBO score was no surprise to anybody” — by removing the ACA’s individual mandate, it followed naturally that fewer people would buy insurance.
That stance — and the one on indirect costs — show if nothing else that Harris is not one to shy away from unpopular positions.
“He’s not one who just loves to speak out,” said North Carolina Rep. Mark Meadows, the chair of the conservative House Freedom Caucus, of which Harris is a member. “But when he speaks out, people listen … and he’s also willing to take very difficult stands, being on the Appropriations Committee.”
Yet on the issue of indirect costs, Harris has failed to generate much traction — Democrats uniformly oppose it, and Republican influencers seem to find the idea half-baked at best.
Many in Washington would be surprised if Congress passes a full budget in September, in any case. And even if there is a budget, said Rep. Tom Cole of Oklahoma, the Republican who chairs the appropriations health subcommittee, 2018 is too quick a target for a major change to the NIH’s funding structure.
“Anything we did, we would phase in over time,” Cole said. “But I’m not prepared at this point to say that we’re doing things wrong. I think it’s an interesting question to be discussed.”
Cole, who called Harris “one of the most gifted members of the committee,” did agree with Harris that if any cap on indirect costs is instituted, the savings should go toward funding additional research instead of padding the federal bottom line.
But the argument that such a cut would not diminish the quality of research “has not been made very well,” Cole said, who added that he heard that case made mainly by budget hawks and not academics.
“The people that are making it to me are not scientists or researchers or people that run [research facilities],” Cole continued.
All of them, of course, except for one.