Field of Science

Congress is killing medical research


Congress is killing medical research.  The tragedy is that they don't want to, but they may do it anyway.

While the ridiculous posturing about the U.S. budget deficit drags on, seemingly without end, biomedical research in the U.S. is crumbling.  Congress's chronic inability to pass a budget, and especially the delays this year, are deeply damaging the core of our entire biomedical research enterprise: the National Institutes of Health.

Outside the beltway, the current battle over the budget probably looks like the usual blustering drama that Congress has been engaged in for years.  Somehow they always come up with another budget, don't they?  They'll tout it as a compromise where no one is very happy, and we move on to the next fight.  Business as usual, right?

Wrong.  There are very real consequences to Congress's inaction, and they are happening right now.  The "continuing resolution" that Congress passed in the fall, which allowed the government to avoid a shutdown, only runs until March.  It includes a 10% across-the-board budget cut to everything.  That includes most of the critical medical research in the U.S.  

Every year, many NIH projects end and many others begin.  (Most only last 3 or 4 years.)  But not this year.  Because of the budget shenanigans, NIH has been forced to cut or delay funding to almost all new projects.  In other words, biomedical research that has already gone through rigorous peer review and been given top priority is on hold.  And just to be clear: these are only the best projects.  80-85% of projects submitted to NIH, many of them excellent, don't make the cut because NIH just doesn't have enough funding for them.

While the budget is in limbo, many talented students, postdoctoral fellows, and research scientists who might work on these projects - some of them just beginning their careers in science - will have to find other work.  Some will go to industry, and some may leave science for another field.  Some of them won't come back.  This is a loss that is hard to measure.

For readers who might think I'm asking for a lot, think again.  The entire NIH budget comes to about $31 billion, which supports research on hundreds of diseases.  The total U.S. budget last year was 3,729 billion (3.7 trillion), so the NIH budget is less than 1% of the total.  A 10% cut from the NIH budget (the so-called "sequester" plan) would save 0.08% of the federal budget.  This matters not a whit in the overall budget debate - but it would be a huge blow to biomedical research, crippling some research programs for years to come.

And for those who want to look at this from an economic perspective , NIH funding is a terrific investment.  A nonpartisan study in 2000 concluded: 
"Publicly funded research in general generates high rates of return to the economy, averaging 25 to 40 percent a year." 
The same report provided detailed examples showing about how NIH-funded work saves billions of dollars per year in health care costs.  But keep in mind that most of these benefits don't appear for many years.  The private sector simply won't make such long-term investments.

If you are reading this, you either already benefit from medical research, or you will some day.  Even if you are in perfect health, someone close to you probably uses a treatment that was supported by NIH. Virtually every major medical center in the United States depends on this funding.  There are few investments with broader impact, and broader public support, than biomedical research.

Does Congress really want to kill medical research?  I think the answer is very clearly no.  The damage to our biomedical research enterprise is entirely unintentional: it's collateral damage in the never-ending partisan fights that consume Washington these days.  Those fights are about power and politics, not science and medicine.  Everyone, even the most intransigent Congressperson, wants better treatments for cancer, heart disease, genetic diseases, infections, and the many other illnesses that afflict us.

So I'm asking the leaders of Congress (yes, I'm talking to you, Congressman John Boehner and Senator Harry Reid) to put aside the fighting for a few minutes.  Bring up the NIH budget and pass it.  Don't cut it by 10% (the "sequester" plan), which would be devastating to biomedical research and would save only 0.08% of the budget.  Don't bundle it into some omnibus "grand bargain" that everyone knows is neither grand nor a bargain.

If they will simply vote on it, I predict that both houses of Congress will pass the NIH budget with overwhelming majorities, and for a brief moment, the country might even admit that Congress was doing its job.  I'll pledge right here to write a blog post titled "Congress delivers a victory to the American people."  So go ahead and do it.  I dare you.

[Disclosure: Like most biomedical scientists in the U.S., I receive funding for my research from NIH.  And also like most biomedical scientists, all of my lab's discoveries are freely shared with the public.]

9 comments:

  1. I'm totally with you on the importance and urgency of maintaining NIH funding for research, but I won't buy the argument that it's just "partisan fighting". That's rather like reporters who refer to outright scam treatments as "controversial". It is republicans who refuse to bring things to votes and many of the core (tea party) obstructionists don't give a damn about science or research (think Michelle Bachmann).

    This farce will continue until we rid the House of fundamentalist extremists who, frankly, don't have a real brain between the lot of them. Two parties is great, loyal opposition is important, INFORMED argument is essential, but what we have is far from any of that. I'm not putting democrats on any sort of pedestal of intellectual virtue, but they do tend more to asking for and accepting expert opinion.

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  2. Janet, I sympathize with your point, but many Republicans (most, I would argue) are highly supportive of medical research. Even the obstructionists, as irresponsible as they are, will probably change their tune as soon as they, or someone they care about, is in need of critical medical care - for cancer, heart disease, or any of the many other things that affect all of us some day.

    So I don't want to blame anyone for the NIH funding crisis. I just want them all to act responsibly and do their job, which is to set priorities and pass a budget each year.

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    1. That is my point--nothing gets done because of blatant and ideologically based obstructionism--which is not coming from the left. I was speaking more broadly and including things like energy and climate change and I guess you were only referencing medical research.

      I think you are looking at it too narrowly and isolating medical research. If you are waiting for the tea party bunch to "act responsibly", I think you will have a long wait. One or two will come around when a relative suffers, as you said, but that won't get things moving any time soon. Portman came around on gay marriage in that vein, but I'd be surprised if that budges the party platform.

      Lastly, as a senior (egad...can't believe I typed that!) I don't want to trade social security for research, so I appreciate democrats not compromising my pathetic little check right down the toilet. If the only way we can pass a budget is to sell out old people, I think we need to find who is to blame rather than hope for a sudden turnaround of a party that thinks I and millions of other older women are a bunch of "takers" for not wanting our SS reduced in the name of a trumped up deficit "crisis". There is no reason we cannot do SS and medical research, but I'm pretty sure I'll be long gone before a significant number of Republicans see the light on the importance of basic science.

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  3. Steven,

    Given the scale of disagreement on the large budget talks, I would like to see more effort towards specific budgets, not omnibus bills. The skeptic in me thinks that they prefer not to do this because they can't hide pork as easily. But I can see that they might view a small step like simply passing the NIH budget as not significant enough for their time.

    Also, I think scientists need to push harder on their friends/neighbors/representatives to understand that the NIH budget (or general science budget) is negligible compared to the overall US Budget, and that cutting it would not improve the debt picture at all. Unless they are cutting from the big three, nothing else really matters.

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  4. While I believe that this whole situation is mostly a manufactured crisis for political purposes, and I certainly agree that a 10% across the board cut is foolish, and I totally agree that money given to NIH is money well spent, I'm squeamish at your assertion that "A 10% cut from the NIH budget would save 0.008% of the federal budget. This matters not a whit in the overall budget debate."

    The problem is not with the statement taken narrowly, but the knock-on implications. The budget is not a single large piece plus a small NIH piece, it's a collection of a whole bunch of NIH-funding sized pieces. NIH isn't all that big when taken as part of the budget, but neither is highway funding, EPA funding, etc. Even with something big like "military spending", you can look at the particulars and split it into particulars like veteran's health services, and airstrip maintenance at base X, and ...

    It's the sorites paradox - no particular line item in the budget would make all that much difference if you fully funded it, but taken all together they would. One of the reasons we're in the budget situation we're in is there isn't any single item in the budget we can agree is over-funded - if there was, we'd have cut it by now.

    Arguing "my piece is special, so we should fund it and leave the cuts to other pieces (i.e. the ones you guys like)" is basically why we're stuck in the situation we're in now. Perhaps changing the dialog from "which programs have greater than 50% approval to cut" to "which programs have greater than 50% approval to save" may help ease gridlock, but it's pushing it to say that funding one program at the (implicit) expense of another "matters not a whit".

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    1. I don't agree that we're stuck because everyone is arguing to hang on to his piece. There are just 3 very large pieces (Soc Sec, medicare/medicaid, defense), and we have to cut those to make a dent in the deficit. We should either cut those, if we really think the deficit matters, or increase taxes to pay for them, or just run large deficits (which seemed just fine to Congress when George W Bush was President). This is a debate we are not having. But cutting science funding makes no difference to that non-debate.

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  5. @RM - You are partly right: Each piece of discretionary spending makes up only a small portion of the overall budget. Even including defense spending, we're only up to about 1/3 of the budget ($1.2 trillion). Exclude defense, and it's only about $500 billion. The *deficit* is $1 trillion. 10% cuts it like trying to bail out the Titanic with a thimble. Maybe it helps you feel like you are doing something, but you're going to drown just as fast. In fact, since many of those discretionary funds (like NIH, NSF, health, transportation, education, etc.) actually *save* money in the long run, cutting them tends to actually *increase* the budget. So probably a better metaphor would be trying to save the Titanic by cutting more holes in the hull in order to "let the water out."

    (These numbers are based on the 2011 budget)

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  6. I think the key here is that the consequences of cutting NIH funding in the long-term are likely more devastating than other areas. When an investigator has less money coming in, he or she cannot hire as many postdoctoral researchers, assistants, or technicians, and may not be able to support research for new graduate students. So not only may people leave for industry or another field, they might not have the opportunity to gain the valuable graduate research experience at all. Why put forth time and money in STEM initiatives if we are not willing to support the scientific careers and research? Furthermore, biomedical research programs don't function as on/off. If you cut funding for a time, it will several times longer to get back to where you started when the money starts flowing again. During that time we will have lost on countless new scientific discoveries and medical breakthroughs... Many of which save us (and the government) money by reducing severity or incidence of disease. If the government isn't going to drastically cut spending where it's needed, they should at least venture to keep the tax payers healthy so we can go on paying for it!

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  7. I think there isn't much that we can really do to salvage the situation. What the congress has decided is most certainly going to be the final and only conclusion that the rest of us would have to abide to. It is really not something to look forward to because medical research is indeed a very important issue that we need to tackle immensely. Our lives depend on our health as a whole on a daily basis and that is part of medical research as well. If we are going to reduce the efforts or put a complete halt to it, then I am afraid everybody is going to be directly affected either on a small level or a huge scale.

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