An NIH program pays school debt to keep scientists in academia. Many break the rules by also taking industry money.
ILLUSTRATION: STEPHAN SCHMITZ/FOLIO ART
Joshua Bauml, a University of Pennsylvania (UPenn) oncologist, received welcome news last year: He had won a coveted spot in the National Institutes of Health (NIH) Loan Repayment Program (LRP). Since 1988, the program has aimed to keep promising young biomedical scientists in academic research by helping repay school loans that can run up to hundreds of thousands of dollars. Without it, supporters say, many of these researchers might have chosen lucrative slots at pharmaceutical companies or in private practice.
Bauml, who finished medical school in 2008, says he will get $75,000 in tax-free loan repayments during his first two LRP years and hopes a renewal will further pay down his debt. He also became a program “ambassador”—a model of success who counsels applicants.
Bauml has another distinction, too. A Science investigation has shown that he, like more than one-third of the 182 clinical scientist ambassadors whose years of participation could be determined, broke the program’s rules against certain forms of industry funding. (NIH’s own analysis finds a smaller number of violations.) The extensive rule breaking—inadvertent in Bauml’s case, he says—is leading some observers to question the public purpose and fairness of a generous taxpayer subsidy for young scientists. “In this presumably exemplar program … you see widespread flouting of the rules, and no one seems to care,” says Vinay Prasad, a hematologist-oncologist at Oregon Health & Science University in Portland who studies industry influence on medical research.
Since 2004, the LRP has paid nearly $1.1 billion for more than 22,000 new or renewal awards to researchers, including about $72 million in fiscal year 2018. Ericka Boone, its director for the past 4 years, said via email and in interviews that the program supports “mission-critical” NIH priorities by preventing school debt from creating “a vacuum of research innovation and discovery.” Recipients, she added, have excelled in gaining funding; publishing research in basic science, clinical trials, and public health; and serving in institutional leadership roles up to 15 years after receiving federal benefits.
Other taxpayer-funded student loan forgiveness plans have a similar rationale: They free recipients from debt so that they can serve the public interest. But these programs tend to be highly competitive and forcefully policed, and often require lengthy government or public service commitments. A Department of Education program for public servants requires at least 10 years in government or nonprofit jobs and awards benefits very selectively.
The LRP offers a sharp counterpoint. Applicants compete on scientific merit, but half win acceptance. The LRP generally does not consider financial need. Although many of the academic-scientist recipients earn relatively modest salaries, taxpayers also repay school loans for physician researchers who rank in the top 1% to 2% of all U.S. wage earners.
Over its history, the program has at times allowed recipients to accept industry support—either by direct payments or research funding—in unlimited amounts. As a result, the LRP in effect subsidizes some young scientists as they build strong ties to pharma. In addition, lax policing and confusing rules about acceptable forms of corporate support mean many recipients end up reaping even more industry largesse than the rules allow.
Bauml accepted more than $28,000 in pharmaceutical industry money, mostly for consulting or speaking at pharma events, during his first 6 months in the program. That was within the rules: Although the program previously barred such payments from drug companies, NIH reversed the policy in 2017. During the same period, industry also underwrote $473,000 of Bauml’s research. For Bauml, this was business as usual. Drug firms had previously given at least $3.2 million for his work, in a steady flow leading up to his LRP award. The practice was allowed until 2017, but the latest program rules banned it, placing him in violation.
Bauml says he was shocked to learn from Science that he had broken LRP rules. He says he disclosed everything to NIH, and heard no objection. (NIH declined to verify disclosures by any recipient.)
Prasad calls the LRP’s permissive approach “ethically problematic.” He and others say the program should be more vigilant about industry payments to the researchers it helps. “Something designed to keep early-career investigators in academia can instead have the function of basically being a supply pipeline to industry,” says Leigh Turner, a bioethicist at the University of Minnesota in Minneapolis. The result, he says, can be long-term financial dependence, regardless of whether a researcher stays in academia.