It was an elephant in the room: Drug pricing has been a key focus of President Donald Trump's narrative on the drug industry since even before he took office. But in a White House meeting on biomedical research Monday, which included executives from drug companies as well as academic and government health leaders, the topic didn't come up.
The group was invited to the Oval Office after the two-hour meeting to share conclusions with the president, Collins said. Trump didn't participate in the main part of the event, which was attended by Ivanka Trump and Jared Kushner, Health and Human Services Secretary Tom Price, and initially by Vice President Mike Pence.
The main focus, Collins said, was "the case for support of biomedicine in America."
"The real intent here was to try to have these various participants in this amazing ecosystem of American biomedicine talk about how all these parts have to fit together in order for the discoveries ... the medical advances, the cures for disease, to continue to happen at a very exciting time in terms of an accelerated pace," Collins said.
The meeting came after Trump proposed cutting the NIH budget by almost $6 billion next year, or about 20 percent; however, Congress, in its most recent spending deal, allocated an additional $2 billion to the agency, which drives biomedical research in the U.S.
Collins said the representatives from the administration "asked hard questions, as well they should."
"They asked a lot about what's happening to young investigators," scientists at the beginning of their careers, Collins said. "Are they finding this to be a time where they can go forward?"
One attendee of the meeting, according to Collins, said that, for the first time, her post-doctoral fellows from China, who were receiving training in the U.S., were declining to stay in the country after they finished, instead returning to China.
"That can't be a good thing for our future if we're trying to build a future that's based upon talent," Collins said. "A lot of the talent that we take for granted no longer comes so easily or stays once they've been trained."
There are already reports of a negative impact on biomedical startups and research as a result of Trump's proposed cuts.
And young scientists are having a hard time finding funding for their work, something Collins said was part of the discussion.
"We would hope that with some good decision-making that we would get from where we are right now — where if you send your best ideas to NIH, your chance of getting funded is less than 20 percent — back up to a place which was historically more healthy, more like 30 or 35 percent," Collins said.
"That's still pretty tough business — most of the time you get turned down — but, right now, it's sufficiently stringent that we know we're not funding a lot of good science and we're discouraging some young investigators who ultimately may decide to give up," he said.
Executives from the drug companies, reprieved from discussing the industry's pricing practices — about which Trump has said pharma is "getting away with murder" — focused on the case for government funding of basic scientific research, Collins said.
"Some have argued maybe we don't need the government involved in research," Collins said. "The companies, one by one, unanimously said, 'That won't work.' They count on NIH to fund the basic science. Their shareholders would never allow them to fund that kind of science."
Collins also said there was a lot of discussion about specific scientific opportunities, particularly on problems in the brain, such as Alzheimer's, Parkinson's, schizophrenia and traumatic brain injury. The main focus: how to ensure that U.S. dominance in biomedical research continues.
"We talked a lot today about how that message gets across," Collins said. "That America wants to support this, that this engine is a big part of who we are; it's a big part of our future."