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Red, White and Budget Cuts

How politics are tied to biomedical research

   For virtually his entire administration, President George W. Bush has financed his decision to invade Iraq and fight in Afghanistan, while generating the largest defense budget since World War II. Since coming to office, the administration has increased baseline military spending by 30 percent, to $515.4 billion. The national defense budget rose 10 percent this year alone.
   To accommodate these increases, other budgets have been cut. For example, spending has declined for the justice department, public housing programs, the U.S. Forest Service, literacy initiatives, the Environmental Protection Agency and biomedical research.
   While each of these line items would argue its function in the country is requisite to  American values, perhaps none would be more entitled to claim its importance for humanity than biomedical research. It’s this work that leads to treatments and cures for health conditions and diseases, arguably saving more lives and lending more to quality of life than any other endeavor. As medical watchdog and blogger Randall Parker put it, “Biomedical research funding will deliver more benefit per dollar spent than any other form of government spending.”
   The 2007 budget proposed what is in real dollars the first cut in spending at the National Institutes of Health in its history. According to an American Association for the Advancement of Science report on the Fiscal Year 2008 NIH budget, funding will fall $329 million or 1.1 percent to $28.8 billion in 2008 from the recently finalized 2007 budget. With a budget of nearly $30 billion, the NIH is the largest government funder of biomedical research. The Centers for Disease Control and Prevention (CDC) and National Science Foundation have budgets of approximately $5 billion.
   The report went on to say that under the current proposal, the “NIH would continue to fall well behind its own calculations of biomedical research inflation, estimated at 3.7 percent both this year and 2008. The NIH budget would fall 12 percent from 2004 to 2008 based on these calculations, and 8 percent based on economy-wide inflation.”
   Was this bound to happen? For years under President Bill Clinton, the NIH enjoyed 14- to 15-percent budget increases. In 1998, Clinton proposed a $1 billion boost for the National Institutes of Health. He and Congress talked of doubling the agency’s budget in five years.
   And they almost did it. Between 1999 and 2003, the budget went from $15 billion to $26.4 billion. But since 2004, annual increases have hovered around 2 percent. This marks the fifth consecutive year the NIH budget failed to keep up with the rate of inflation in the cost of conducting biomedical research. Funding for NIH increased by 1.1 percent whereas the cost of conducting research is estimated to increase between 5 and 6 percent every year.
   Some argue the correction was necessary. In a 2006 editorial in the journal, Medical Hypotheses, British researcher Bruce G. Charlton, argued, “As funding increases, diminishing returns will set-in, opportunity costs will begin to bite, and there will be more and more social benefit to be gained from spending the extra research money on something else.” He suggested that after a short term “quantitative decline of research production,” a more efficient medical research system will emerge. “Perhaps,” Charlton wrote, “a renaissance of medical research lies not too many years in the future.”
   But others say a loss of research production will hurt U.S. standing as the world leader in biomedical advances. In an August 2001 speech, Bush applauded the, “long and proud record of leading the world toward advances in science and medicine that improve human life.” Yet, critics such as Mary Woolley, president and CEO of Research!America, an advocacy group funded by many organizations and the pharmaceutical industry, say this is the legacy that spending cuts threaten. “Sadly,” she said in a statement about current funding, “the White House no  longer seems to view such spending as a priority. Today, the National Institutes of Health is only able to fund two in 10 qualified medical research projects. The president’s 2009 budget recommendation could slow this rate even further—proposing no increase for the NIH and budget cuts for the Centers for Disease Control and Prevention and other health agencies.”
   Increasingly, scientists decry the slump in federal research funding as a setback for medical progress, saying it jeopardizes the country’s dominance in science, just as competition in Europe and China is growing.
   “We’re mortgaging our future by not funding this research now,” said Nobel laureate, Thomas Cech, president of the Howard Hughes Medical Institute. Cech was referring to the recommendations of a new study he chaired by the American Academy of Arts and Sciences. In order to preserve U.S. leadership in science and technology, the June 2008 White Paper says there must be targeted programs and policies to support early-career investigators and high-risk, high-reward research.
   The report, “ARISE: Advancing Research In Science and Engineering,” went on to say that its committee, “decided not to distract from its message about modes of funding by tackling budgetary issues.”
   That’s the problem, according to Dr. Herbert Sohn, medical facility entrepreneur and attending urologist at Weiss Memorial Hospital in Chicago. Sohn, who is also an attorney, has been active in medical politics for decades, with several runs for Congress in the 1980s and 90s. Today he sits on numerous committees, including the Wye River Group on Healthcare, a 20-year-old nonpartisan, nonprofit organization to promote healthcare reform, and the Institute for Truth in Accounting, an organization striving for increased credibility in financial reporting.
   Sohn says no one wants to sit down and discuss funding, so they, “shove it under the rug. There aren’t people willing to bite the bullet and figure out how to pay for things.  You need money to take care of things. But it’s difficult for politicians to say, ‘Increase taxes.’ We have to go into savings first—how to save. In order to do that, we have to have people in Washington willing to pay attention to it.”
   Because, as a spokesperson for the NIH says, “It’s Congress that appropriates the money. They give us our funding, and we’re grateful for it.”
   Other researchers are grateful for funding sources outside the U.S. government. Just before the AAAS report was released this spring, the Howard Hughes Medical Institute announced it would provide $600 million to the “nation's most creative biomedical scientists” willing to “tackle their most ambitious, risky research plans.”
   Private biomedical research funding now constitutes more than 10 percent of the total money contributed to research, with the pharmaceutical industry providing the most funding, and the U.S. government providing about half as much as industry. In general, pharma focuses on developing and testing new products, the government supports basic research, and foundations generally fund some of what’s left over.
   Historically, the government has provided funding for initial investigations, and after a breakthrough, pharma translates the basic science into medical applications and advanced technology. Advances in understanding and treating AIDS and HIV are an example of this model. But, says Woolley of Research!America, the system of government funding leading to industry breakthroughs will collapse if public funding doesn’t keep pace with opportunity. Speaking on Radio XM’s ReachMD talk show last fall, she said, “We believe we’re going to see a flattening or even a decrease in pharma funding for medical research that will follow what we’ve seen at the NIH. The concern is that this slowing, both through publicly funded and privately funded ways, really compromises the robustness of the industry. Big pharma has a global reach, but they depend on research conducted in the U.S.”
   A lot seems to depend on research conducted in the United States. Private industry and the U.S. government together provide 35 percent of the world’s total research and development funding. Or they have. According to Woolley, the percentage of investment is going down. “The problem is people aren’t speaking out. Many members of the public as well as health care professionals don’t even know where their elected officials stand on key health-related issues, with the possible exception of tort reform.”
   According to Woolley, the most concerning declines in research are in breast cancer clinical trials and Alzheimer’s disease. “Just at a time when science opportunity is higher than ever,” she said, “we’ve decided as a nation, via our elected officials, to freeze funding in medical research at the NIH, at the CDC, at the NSF. It’s pretty much across the board.”
   Ironically, decreased funding comes at a time of rising health care costs to individuals and with the knowledge that in 2002-03, the last year of the large NIH budget increases, the number of people who died from cancer decreased for the first time.
   It’s not that there are no advocates in Congress for increasing biomedical research funding. In fact, there are many. In Illinois, Democratic Senators Barack Obama and Dick Durbin both advocate increased investment in NIH. Their positions are outlined on the voter education website, Your Candidates–Your Health 2008 (www.yourcandidatesyourhealth.org). To date, Senator John McCain has declined to participate.
   In the initiative, launched by Research!America, the Albert and Mary Lasker Foundation and other partners, all members of Congress were invited to complete a questionnaire telling Americans where they stand on a range of research and other health-related issues. Members of the public can take the same questionnaire and compare answers.
   Once they’ve done that, individuals should contact their political representatives. “Now is the time for advocacy,” Woolley says. “Members of Congress will listen to their constituents. Remember, your voice counts.”

Published: August 09, 2008
Issue: Fall 2008 Politics Issue