Trump's budget proposal eviscerates biomedical research, for no good reason

Donald Trump proposed a budget this week that will cut funding to NIH by nearly $6 billion, or 20% of its $31 billion budget. A cut of this magnitude would be devastating for biomedical research, and for the health of the nation.

This is colossally short-sighted, stupid, and even cruel. The U.S. budget this year is $4.0 trillion, which means that the entire NIH budget is only 0.75% of the budget. A 20% cut to NIH, while incredibly damaging to medical research, would only reduce expenditures by 0.15%.

Besides being shortsighted, this proposed cut is heartlessly cruel. What diseases, Mr. Trump, do you want people to die of? Should we halt research on aging? (Not a good idea for 70-year-olds like you.) How about cancer, or diabetes, or infections, or schizophrenia, or heart disease, or lung disease? Or maybe Trump wants to eliminate the NIH Children's Inn, where desperately ill children stay while receiving treatments. The list is very long; NIH supports work on 265 diseases and health conditions.

Everyone who is reading this either already benefits from medical research, or 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.

For those who want to look at this from an economic perspective (as I explained in 2013), NIH funding is a terrific investment. A nonpartisan study in 2000 concluded that:
"Publicly funded research generates high rates of return to the economy, averaging 25 to 40 percent a year."
That's an amazingly good investment. The same report provided detailed examples showing 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.

On a more mundane level, NIH generates thousands of jobs in states all across the nation. If you want to see how it affects your state, check out this graphic from United for Medical Research. Do you live in Ohio? NIH directly supports over 11,000 jobs and $670M in funding, affecting 2,500 businesses in your state. Florida? Another 11,000 jobs, $520M in funding, and over 5,000 businesses. Texas? 21,000 jobs and over $1B in funding. And so on.

Does Congress want to kill NIH? I seriously doubt it. Does Donald Trump? I'm just speculating, but I think the ansswer is no. I think Trump doesn't understand what NIH does, but that someone in his inner circle–someone with a wildly distorted worldview–has inserted his own warped ideology into the President's budget proposal.

Finally, what's the motivation for these cuts? The U.S. economy is doing quite well, far better than it was in 2008 when Obama came into office. The economy then was in a devastating recession, but we didn't implement drastic cuts then, and we climbed out of it. We've had low unemployment and steady growth for years. It's not clear we need to cut the budget at all, much less make draconian cuts that would eviscerate and eliminate enormously beneficial programs. And if Trump wants to reduce spending, it makes no sense to cut programs that collectively only represent a tiny part of the total. One can only conclude that Trump's proposed budget cuts are entirely ideological, not financial.

Fortunately, budget making authority in the U.S. rests with Congress, not with the President. Let's hope that Congress will ignore this shortsighted, cruel, and pointless proposal to cut medical research to the bone, and instead will continue to invest in what is, for now, the strongest biomedical research community in the world.

The new EPA Chief is a climate denier: why are you surprised?

On Thursday, newly appointed EPA chief Scott Pruitt said he doesn't think human-driven carbon dioxide emissions cause global warming. The internet exploded with outrage.

Why so surprised? We already knew that Scott Pruitt was a climate change denialist.

Donald Trump is also a climate change denialist. Why is anyone surprised that Trump is appointing other denialists to top posts in his administration?

During his campaign, Trump claimed that climate change was a "hoax" perpetrated by the Chinese. Mr. Trump just made that up: it's complete nonsense, and he would be laughed out of the room in a serious discussion of climate science. Unfortunately, he now has too much power for us to ignore him.

The Secretary of Energy, former Texas governor Rick Perry, has also been a climate change denier, although he "softened" his position during his confirmation hearings. At those hearings, Perry said
"I believe the climate is changing. I believe some of it is naturally occurring, but some of it is also caused by man-made activity." [Secr. of Energy Rick Perry]
How refreshing! What really matters, though, is whether we'll Perry's newfound awareness will be reflected in actual policy, or whether it was just a pose he adopted for the hearings.

Scott Pruitt, though, is unreprentant. Pruitt has spent much of his recent career suing the EPA on behalf of oil companies (despite the fact that he worked for the state of Oklahoma, not for those companies). Oil companies, coal companies, and others who make their money from fossil fuels–notably the Koch brothers and their fake-science-pushing Heartland Institute–have devoted millions of dollars and years of effort to climate change denialism. We already knew Scott Pruitt was one of them.

On CNN, Hawaii's Senator Brian Schatz commented:
"If there was ever any doubt that Scott Pruitt is a climate denier, this settles it."
Sen. Schatz is correct, of course–but there wasn't any doubt in the first place.

The New York Times couldn't have been surprised. Just two days before Pruitt's on-air denial, they ran a story headlined "E.P.A. Head Stacks Agency With Climate Change Skeptics." The Times pointed out that Pruitt's chief of staff and top deputies are former staffers of Senator James Inhofe, one of the Senate's leading climate change deniers.

I do have a major disagreement with The Times, though: stop calling these people "skeptics." They are not skeptics. A skeptic is someone who insists on solid evidence before accepting claims about science, medicine, or other fact-based issues. Once evidence is produced, a good skeptic acknowledges the evidence and changes his/her views, if necessary.

Denialists, in contrast, stick to the same rigid narrative regardless of the facts. When evidence contradicts their views, they have no choice but to deny, deny, deny. When pushed, they obfuscate and delay, often arguing that the evidence is not yet clear and more studies are needed. This is precisely what EPA head Scott Pruitt and his boss, Donald Trump, have been doing with climate change. Pruitt argued on Thursday that "we need to continue the debate and continue the review and the analysis." No, we don't. The evidence is overwhelming that the planet is warming, that rising CO2 emissions are a major contributor to that warming, and that human activities are causing much of it.

The Intergovernmental Panel on Climate Change (IPCC), summarizing the work of thousands of scientists from around the globe, has concluded with very high confidence that human activities are the primary driver of climate change. They've also explained (hello, Scott Pruitt?) that carbon dioxide is the most important human-driven cause of global warming, and that it has increased 80% since 1970.

Because Scott Pruitt is a denialist–not a skeptic–he will simply deny these facts.

The New York Times and other media need to stop calling Pruitt a skeptic. Skepticism can be healthy; all good scientists are skeptics. Denialism, on the other hand, can lead to great harm. Cigarette companies were not being skeptical when they denied, for decades, that cigarette smoking causes cancer. They too called for more research. They were protecting their profits, and millions of people died while the companies denied and delayed.

Oil and coal companies are now playing exactly the same game, sowing doubt in order to preserve their profits. Scott Pruitt demonstrated this when he claimed, on CNN, that "there's tremendous disagreement about the degree of impact [of human CO2 emissions]." No, there isn't. Quite the opposite is true: there's remarkable agreement among climate scientists that humans are causing global warming. The only source of disagreement is the profit-driven fossil fuel industry, which cares far more about its short-term profits than about the world that future generations will inherit.

So let's not be surprised when Trump and his minions deny climate change, or deny that human activities are causing it. Perhaps it would be better to consider what the harms will be, and whether we can prevent them. Just don't expect any help from the government.