Sir

In the current discussion about the US National Institutes of Health (NIH), its director and its direction1,2,3, we have heard much about the fact that funding will probably not increase for the foreseeable future, and about the many challenges confronting the organization.

Clearly, where there is adversity, there is opportunity. Thus, one cannot help but agree with Michael Bishop and Harold Varmus that the way forward lies in “making common cause with the leadership of NIH”2 and joining forces. Unfortunately, an issue that has been overlooked is exactly how to make this happen.

Many NIH-funded investigators ‘in the trenches’ are very unhappy right now, not only because funding is tight, but also because they are frustrated by a lack of ready access to, or input in to, global funding decisions and important policies. I suspect that if there were more discussion about these critical issues, then investigators would be much more understanding and even at ease. Instead, it seems as though there is a wide communication gap between those who make decisions about funding (Congress and the NIH leadership) and those who do and direct so much of the research that the funding supports (typical scientists).

Many investigators are so busy with research, patient care and administrative duties that time for such exchange is limited. Nonetheless, both the NIH and the biomedical-research community would benefit from thoughtful, transparent discussion about biomedical research in the United States in a structured forum. It could even lead to productive action.