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.

Let's speak up for research that saves lives

In this week’s Science magazine, former Republican Congressman John Porter calls on scientists to “speak up for research.” Well, I’m all in.

We’re in the midst of a remarkable stream of scientific and medical advances, spurred by dramatic advances in biotechnology, computing, and miniaturization. Our knowledge of biology has led to amazing leaps in our understanding of aging, immune responses, inherited diseases,  and brain function, to name but a few. And yet we're cutting science funding, year after year. As Porter writes,

“the general public, and in particular elected officials, have failed to embrace the promise of cutting-edge science as a means to improve health and the economy.” 

Somehow we found (or borrowed) $2 trillion dollars to spend on wars in far-off countries whose citizens don’t like us - a cost that will at least double before we’re done paying the bills. And some politicians this past week were demanding that we invest billions more in Iraq, money that we don’t have. It's touching how concerned they are for the citizens of Iraq.

Meanwhile, eight of the top 10 causes of death in the U.S. are diseases that we might cure through better research, including heart disease (#1), cancer (#2), Alzheimer’s, diabetes, and kidney disease. We already have far better treatments for these diseases than we had a few decades ago, thanks to our past investments in biomedical research.

In this column over the past few years, I’ve highlighted just a tiny sample of the remarkable advances coming out of the scientific world, such as

• a breakthrough cure for some forms of leukemia; 
• a new, less invasive prenatal test for Down Syndrome and other chromosomal abnormalities; 
• stem cell treatments that can repair damaged hearts; 
• a promising breakthrough in Alzheimer’s treatment; and
• stem cells to treat blindness. 

Curing these diseases will not only save lives - it will also save money. A nonpartisan study revealed that publicly-funded research generates returns of 25 to 40 percent a year. And former Congressman Porter explains,

“If a treatment became available in 2015 that delayed the onset of Alzheimer's disease by 5 years annual Medicare and Medicaid spending would be $42 billion less by 2020.”

Without investment in research, though, these treatments will never arrive. Meanwhile, we’re spending $400 billion (13 times the entire annual NIH budget) on a new fighter plane that won’t even be ready to fly for another 5 years, after which the Pentagon says it will cost $850 billion to keep it going. We’re spending billions more on military equipment that even the Pentagon doesn’t want, such as the Global Hawk drone program, which Congress is forcing the Air Force to keep.

Obviously, the military-industrial complex has better lobbyists than we in the biomedical research world have.

We don’t invest in research just to make money, though. Make no mistake: biomedical research saves lives. We’ve effectively cured many types of childhood cancer such as retinoblastoma and Hodgkins lymphoma, but there are over 200 types of cancer, most of them still needing far more research.

We need elected leaders with the vision to re-examine our priorities and invest in the future. The U.S. scientific research enterprise remains the envy of the world, but it won’t stay that way long if we keep cutting it as we have been.

How much should we invest in biomedical research? Let me put some numbers on the table - not that we can get there overnight, but we could set these as goals and and then figure out how to get there.  How about allocating 2% of our total budget - $75 billion - for all of our biomedical (NIH) and basic science (NSF) research?  NIH’s budget is currently about 4 times the size of NSF; if we keep that ratio then NSF would get $15B and NIH $60B. That’s about twice what we spend now. We've done this before: Congressman Porter and his colleagues advocated a doubling of the NIH budget between 1998 and 2003, and we could do it again.

Congressman Porter wants us to speak up for research. Let’s start now.

Stem cell therapy offers hope for “irreversible” heart damage

In December 2011, I reported on one of the first attempts to inject stem cells into damaged hearts. In that study, published in The Lancet, scientists grew stem cells from patients’ own hearts after the patients had suffered serious heart attacks. These were patients who had serious, irreversible heart damage. As the study leader, Dr. Roberto Bolli, said at the time, 

“Once you reach this stage of heart disease, you don’t get better. You can go down slowly, or go down quickly, but you’re going to go down.”

Amazingly, in that study, the patients got better. 14 of the 16 patients had improved heart function after 4 months, and the results were even better after one year. The stems cells grew into new, functioning heart cells.

That was just one study. Now there have been more, and the results continue to be very encouraging. Just last week, the Cochrane Collaboration published a review of 23 trials, all of them attempting stem cell therapy for heart disease. These trials looked at the use of bone marrow stem cells in patients whose hearts were failing. Unlike the 2011 study, which looked at heart attack patients, these studies looked at patients with advanced heart disease who had not suffered a heart attack. The results: overall, stem cell treatments reduced the risk of death and improved heart function, though the benefits were not as dramatic as in the patients with heart attacks. 

What is most exciting in the newest studies is the long-term reduction in the risk of death. Six of the studies reported long-term results (more than one year) on mortality. In these studies, 8 patients died out of 241 who received stem cell therapy (3.3%). In contrast, 30 patients died out of 162 (18.5%) who did not receive stem cells. The numbers are small, but this is a huge benefit: patients were about 5 times less likely to die. The Cochrane review concluded that

“The risk of mortality over long-term follow-up was significantly lower for those who received BMSC [bone marrow stem cell] therapy.”

An important caveat is that this is still “low quality” evidence, meaning that we need to see more data, on many more patients, before we can have confidence in the results. But it is still very encouraging, especially when no other treatment offers anything remotely this promising for advanced heart disease.

The evidence continues to build that stem cells can repair heart tissue damaged by heart attacks. Just a couple of months ago, Britain launched the largest study yet of stem cell treatments for heart attacks, involving 3,000 patients in Europe. This new review shows that they can help repair some of the damage from other types of heart disease as well.

Heart disease is the leading cause of death in the United States, and we should be pursuing every plausible treatment, though very few exist. Stem cells offer the hope that, for the first time ever, we might be able to reverse heart damage that was previously thought to be irreversible. Stem cell treatments are a true breakthrough, and rather than cutting medical research, as we have been doing for the past five years, we should be pouring resources into this remarkable new medical technology and the therapies that it makes possible.

Which is more urgent: military drones or a cure for cancer?

A Global Hawk drone

The U.S. government has an answer: drones. Drones and other weapons of destruction are vastly more important than healing people - or at least that’s what one might think, based on our government’s spending priorities. In the most recent federal budget, we spent $821.6 billion on defense, which includes $636.2 billion for the Defense Department, $138.9 billion for veterans, and another $46 billion on foreign military aid. We spent just $29.1 billion for the National Institutes of Health, the epicenter of all our research on new cures for disease. That’s a decline of $1.7 billion from 2012 (thanks to the sequester). In the big picture, then, we spent 28 times as much on defense as we spent on curing disease.

Does anyone in the federal government ever step back and think seriously about what our overall priorities are? Or do they just think about whether to adjust a particular agency’s budget a few percent up or down? Congress returns from recess next week, and they’ll make lots of noise about the budget decisions, and then they'll pass something that makes at most a few incremental changes.

A big problem with our short-term approach to governing is that the forces that want to keep everything the same are always more powerful than the forces for change. The people and institutions that benefit from the current budget are already in place, and always at the ready to lobby against change. We desperately need to review our priorities, at least once in a while, and make a rational decision about how much to invest in the things that government does. Do I expect this to happen? No. But that doesn’t mean we shouldn’t try to make the argument.

Here are just a couple of examples of how current spending plans just can’t be stopped, even if they have gone wildly out of control. First let’s consider the Global Hawk drone program, which the Defense Department itself would like to terminate: the Air Force says it has better equipment for the same job. Ending the program would save $2.5 billion over four years. (That’s $2,500,000,000. It helps to write these numbers out.) How did Congress respond to the Air Force proposal? The head of the Armed Services Committee, Howard McKeon (R-Calif.) rejected the proposal and added $443 million to purchase three more Global Hawks. Not coincidentally, the manufacturer of these drones, Northrop, builds them in the district represented by McKeon.

A bigger example is the Joint Strike Fighter program, the most expensive plane in history, which is now estimated to cost $400 billion by the time it starts flying in 2018 - if it’s not delayed further. This is more than triple its estimated cost in 2001, when it was first approved for $119 billion. Just recently, the Pentagon itself reported 147 “major” quality issues with the program. 

We won’t even have these planes for another 5 years, so obviously this hasn’t improved our security yet. And once it starts flying, the Pentagon estimates this fighter plane will cost another $850 billion to keep going. Who decided this was worth it? Is anyone seriously considering scrapping the whole project, before we spend another trillion dollars on it?

There are many more examples, such as the $436,000,000 we’ve spent building new Abrams tanks that the Army does not want. The Army may not want it, but it’s built in Ohio, and the Ohio members of Congress (both Democrats and Republicans) have fiercely defended it. 

It’s not just Defense, of course - we are still funding the 1925 federal helium program, which Congress seems unable to kill. The helium program was started after World War I, when the U.S. was worried that it wouldn’t have enough blimps. Lobbyists are keeping the program alive.

Let’s go back to the big picture. The leading causes of death in the U.S., according to the CDC’s latest figures, are:

1. Heart disease (597,689 deaths)
2. Cancer (574,743 deaths)
3. Chronic lower respiratory disease (129,476 deaths)
4. Stroke (120,859 deaths)

You might expect that we would be pouring money into research on the biggest causes of death in the country - at least as much as, say, a new fighter plane. But you’d be sorely disappointed: the entire U.S. budget for cancer research at NIH's National Cancer Institute is $4.78 billion. That’s for every type of cancer (and there are hundreds). This budget covers clinical research on new treatments, long-term research on understanding cancer, and everything in between. The budget for heart, lung and blood disease (the number 1 and 4 causes of death) is even smaller, just $2.90 billion. 

These numbers are little more than round-off errors when compared to the entire U.S. budget, which for 2013 is $3,454 billion.  The NCI budget is just 0.14% of the total.

How much should we invest in cures for all disease each year? How about 5% of our budget? Or maybe just 2%? That doesn’t seem like too much. Ask anyone who has cancer, or who knows someone with cancer, if 2% of the budget is too much to invest in cures. I suspect that most of them will say it’s not nearly enough. 

2% of the federal budget is $69 billion. Let’s put that on the table as next year’s budget for NIH. Rather than building weapons, let's use our tax dollars to build new things and make new discoveries. Rather than destroying infrastructure in other countries, let’s invest in our future, and create new treatments that make our lives longer and healthier. 

In the current issue of The Atlantic, James Fallows interviewed Eric Lander, one of the world's leading genome scientists, and asked him when genomics would lead to a cure for cancer. Lander responded:

“If we invest vigorously in this and we attract the best young people into this field, we get it done in a generation. If we don’t, it takes two generations. That’s a very big difference.”

Think about it. If we invest more now, you might see a cure for most forms of cancer in your lifetime. Two generations, though, will be far too late for most of us. How many more people need to die from cancers that we’ll eventually be able to cure?

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.]