A Big Hole Where a Cliff Used to Be

Unless you've been climbing rocks on Mars, you think "fiscal" when someone speaks of the "cliff" that Congress and the Obama administration tried to address in the closing weeks of 2012. While nearly every U. S. citizen felt threatened by thoughts of going over that cliff, all should realize that scientists have been facing their own fiscal cliffs again and again in recent years. For scientists those "cliffs" have been more akin to roller coaster dips, thanks to a budget that was never predictable and at times not sustainable. Beginning late in the Clinton administration and early in the George W. Bush administration, federal funding for the National Institutes of Health (NIH) research doubled. Doubling occurred because it was recognized that valuable scientific discovery was being impeded by inadequate funding. Doubling the NIH budget could have set us on the path toward adequate funding for research if funding for the years after the doubling had kept up with inflation, but it did not. As a result, much-needed scientific work that was started when funds were available had to be curtailed as dollars shrank.

With the doubling of the budget, you might feel that scientists are like the comic character Dennis the Menace, who, every Christmas morning, atop a mountain of presents, would ask, "Is that all?" However, you would be quite wrong to make that comparison. Federal funding for research is neither a gift nor a handout to scientists. Instead, it is an investment that pays dividends many times over to the American taxpayer. Research of all types pays huge dividends, but biomedical research, with which I am most familiar, pays its return on the dollar by reducing costs of disease, providing direct employment for many citizens and keeping our country the world leader in medical discovery that aids in treatment and cure of disease. Some might argue that health care costs rise with newly discovered treatments and diagnostic procedures, and that those escalating costs "drive" the federal deficit. To the contrary, discovery provides an opportunity to reduce costs. As a result of research, things that would have been unimaginable even 30 years ago are now routine. The problem with rising costs of health care is more related to financial incentives built into health care reimbursement for use of high-cost procedures than it is in having those novel procedures and treatments available.

The cost effectiveness of biomedical research and development can be appreciated by looking at data collected from 1970 to 2000. For coronary artery disease (heart attacks) alone, the U. S. enjoyed $2.6 trillion in savings, a 63-percent reduction in mortality and 1 million lives saved. Those gains came at an annual cost of $3.70 per American, about the cost of a grande latte. Over the same period, and for the first time in recorded history, the number of cancer deaths began to decrease annually in the United States, and 10 million people survived cancer. That cost $8.60 per American per year, close to the cost of a Big Mac Meal, not generally considered a choice made for health improvement.

Maybe you're hard to please and, like Dennis, still ask, "Is that all?" The problem is that absent appropriate decisions by our elected leaders, the answer to that question could be "Yes!" Well, perhaps that is a bit extreme. The federal government is not planning to stop all funding for research, and some of what it does fund will doubtlessly lead to more discovery and further improvements in medicine and the quality of people's lives. But are you, like me, a bit impatient for some of those discoveries? Do you have any idea what discovery will be missed in the absence of adequate funds? Well, I certainly don't.

Already budget constraints and an unwillingness to find a way to support discovery have led to closure of established, productive scientific laboratories; loss of jobs for people who had worked in those labs; and loss of any chance for the discovery that would be the next stepping stone toward real breakthroughs. Failure of funding for the NIH to keep up with inflation has effectively eroded scientists' ability to conduct potentially lifesaving biomedical research and has forced the NIH to shift money from one important program to another just to keep programs afloat. When we speak of NIH funding, it is critical to recognize where the money goes for discovery. In the United States there is not one state that does not receive NIH research dollars. Those dollars are critical not only for discovery but for jobs within those states. So don't think for a minute that reduced federal funding of research does not affect you economically. Your tax money does not simply go to someone at NIH in Bethesda, Md., a suburb of Washington, D.C. The money and the benefits it makes possible come back to you and your neighbors.

Scientists are themselves impatient and eager to get on with discovery. They realize that discoveries not made leave us weakened in our constant fight against disease and our hope for a better tomorrow. With each new year we celebrate hope. As I rang in this new year, how could I not be agitated and impatient when I realized that discoveries that could have helped my mother, who died of Alzheimer's disease, are being put off due to budget concerns? At a time when friends come together to celebrate, how could I not be agitated and impatient thinking of a young colleague who, at this very moment, battles newly discovered brain cancer? I continue to hold hope that science will find new ways to make his chances of recovery greater. Every one of us has personal knowledge of disease and how it has affected us or those we love. How, then, can we not be agitated and impatient for science to be released from constraints that limit its ability to contribute to discovery and to cures? What are we doing about it? All of us -- scientists, patients and anyone who has suffered from or knows someone who has suffered from disease -- must make our voices heard to our elected leaders. They will listen if we speak, and the more who speak, the more likely it is that they will listen. It is easy to make your voice heard in support of science. Websites such as capwiz.com/faseb/home are designed so that you can speak with little more than the click of a key on your computer.

So as they peer over the landscape below the still-looming cliff, will our elected leaders hear from you? Will they shave elevation from the cliff, or will they make the hole on the other side of the cliff deeper by cutting the very programs that provide greatest benefit both now and into the future? They speak of lifting an economic burden from the shoulders of our children and grandchildren, but will they do so at the expense of leaving our heirs unprepared for what faces them? How will they make choices that provide guidance to budget cuts in some places and budget increases in others so that they end with value added? Understand that these are not easy decisions, but also understand when you advocate to your elected representatives that they must hear from you in order to recognize where federal dollars make the greatest overall impact on the health and welfare of the citizens of our country.

I hope that in this new year you will enjoy the gifts of good health and well-being made possible by scientists worldwide. Continuing to do so demands that you resolve to do your part so that when you ask, "Is that all?" scientists can answer, "No."