If you care about health-related matters, take a second to consider some of the genuine advances we all may take for granted:
- In recent decades, we have reduced by 70 percent the death rate from heart disease and stroke
- We've turned HIV/AIDS from a pandemic death sentence to a chronic, manageable condition
- Our infant mortality rates have declined, though they remain poor in certain segments of our population
- We've developed new or improved drugs to treat countless diseases, including cancer, high blood pressure, high cholesterol and depression.
If you or those you love have battled cancer, high blood pressure, heart disease, depression or any other or a range of diseases and conditions, you should know that, by and large, modern medicine, at its best, can offer you unprecedented cause for hope for a favorable outcome.
So why, my fellow Americans, are we about to let our elected representatives take a blunt ax to pare our federal support for a crucial, fundamental element in our 21st century healthcare -- medical and scientific research? If you're like me, the mere mention of Washington's insular in-fighting -- including chatter about terms like "sequestration" -- makes your eyes glaze over and produces an immediate need for an antacid tablet. But if we all don't watch out, write and call our members of Congress, we're penning a truly glum prescription for biomedical research and the myriad benefits it brings to our national health.
My concern, voiced by my colleagues nationwide and not just out of self-interest, I must emphasize, focuses on what's coming out of Washington about the world's largest supporter of biomedical research, the National Institutes of Health. The deficit hawks want to slash its funding, and, in the complicated scenario that involves our national red ink, the so-called fiscal cliff and "sequestration" -- the draconian cuts that politicos imposed on themselves because they were gridlocked in partisan acrimony -- NIH funding might be slashed by $2.5 billion, or eight percent.
A reduction of this magnitude in our national medical research budget is unprecedented in the history of the NIH. Mere discussion of such a budget bludgeoning already threatens to isolate our nation's best and brightest researchers, forcing them, as they compete even more ferociously in a field with already bracing high standards, to reduce the openness and collaboration that we know helps to make ideas grow strong and produce real advances. It is discouraging brilliant young people already from starting or continuing research careers.
Yes, my home institution competes robustly with other elite biomedical scientists around the planet and is a proud recipient of NIH and other federal funding -- $48 million in fiscal 2012. I consider myself fortunate and grateful for the role the agency let me play early in my career in advancing our understanding of human hormones, resulting in a technology that has proved life-changing for millions of women: a home pregnancy test kit.
Because I see, up close and in concrete fashion, how much this federal support benefits patients, physician-scientists, institutions, communities and the nation, I'm an unabashed advocate who also wants the public to understand clearly and simply what happens with its tax-supported research dollars.
NIH "at the bench"
There are layers and layers of basic research that underlies every new drug from a pharmaceutical company, every new medical device and every new treatment. The NIH is the means by which this nation successfully has promoted work every day to: explore the fundamentals of science at the cellular and molecular level; that sort of information and the knowledge gained goes into new drugs, new therapies and, yes, cures. Much of what the NIH does occurs "at the bench" part of research. Without it, your physician likely could not bring new therapies to the bedside, where it matters most to you and me; pharmaceutical companies could not develop new and improved drugs. Through funding of clinical trials, this federally sponsored research institution helps turn new findings into medicine's growing arsenal of safe and effective options that can reach all patients.
As Dr. Francis Collins, director of the NIH, told Congress in his 2013 request for $30.86 billion in funding, NIH-funded research "has prevented immeasurable human suffering and has yielded economic benefits as well, thanks to U.S. citizens living longer, healthier, and more productive lives."
What could be lost
Will Congress bleed $2.5 billion from the NIH's funding? We know that when it comes to the U.S. budget and the national deficit, the choices are hard and freighted by partisanship. Look, I won't try to fast-talk you here about how easy it would be to slash, say, military spending or subsidies to agribusiness or the oil and petroleum industries.
Consider just one example of what might be lost if the NIH goes under a savage budget knife: funding could be lost for Alzheimer's disease research. An estimated 5.1 million Americans suffer from this devastating form of dementia, with 280,000 newly diagnosed patients each year. By 2030, when the last baby boomer turns age 65, that number will jump to 7.7 million. And the cost of caring for Alzheimer's patients, today $180 billion a year, will soar to $1.1 trillion, if no cure or more effective therapies are not found by 2050. Do we really want to slow down today's researchers in their quest for genes that cause the disease or for possible targets for treatments? That's just one disease. We could make similar penny-wise-pound-foolish arguments for costly and painful illnesses like cancer, diabetes, heart disease, brain afflictions and on and on, closing down research efforts that could well be on the cusp of discovery. In a Jan. 14 news conference, President Obama sounded his concern when he said that the American people don't think it's fair to ask a scientist "to shut down life-saving research so that a multimillionaire investor can pay less in tax rates than a secretary."
Jobs and futures
Let's also understand that the money we spend through NIH grants boosts the economy, while the reverse is obvious: lost billions of research dollars translates to the loss of high-quality jobs. Estimates are that for every $1 spent to support NIH research, $2.21 goes back into the economy, Collins told Congress. And every grant awarded generates seven jobs. With the 2013 budget request, without sequestration slashes, the NIH expects to award 9,415 new research grants, in addition to 35,888 ongoing grants.
Our economy also benefits from more than just direct funding from taxpayers. Basic research, as supported by the NIH, provides a foundation for medical innovation in the private sector. That leads to more jobs. One study showed that in 2010, NIH investment led to the creation of 484,939 jobs, produced $69 billion in new economic activity across the country and allowed 15 states to experience job growth of 10,000 jobs or more.
You know from your own life's work that, besides ambition, desire, talent, skill and education to prepare for your chosen field, you need opportunity. And therein lies one of my major concerns if our nation's leaders slash funding for basic research. This could mean we would lose a generation of scientists. To see how, just follow the money. With more individual scientists failing to receive funding, some will survive, but they'll grumble and grovel and grow more competitive, possibly insular. Junior people hear the grumbles, see the difficulties. Many will decide not to enter their chosen field of biomedical research. Others will give up early careers and enter other fields because they see a profound lack of opportunity.
It takes a lot of time to train a biomedical researcher -- both Ph.D. basic scientists and M.D. medical researchers who can translate laboratory bench research and deliver it at the bedside. The preparation, education and training requires a huge commitment, fortitude and stamina, including excelling in medical school or advanced-degree research training, followed by post-doctoral fellowships. A talented researcher can spend a decade or more just preparing to do the work that the NIH funds. Young scientists already face tough choices. In 1982, those younger than 36 made up 18 percent of NIH primary investigators; it's just three percent now.
We cannot afford to lose more from a young generation of such researchers. If we do so, the consequences could be dire for our nation, its health and its medical-scientific progress.
History provides us with both lessons and a potential inspiration for our course of action on our national support for research. Let's look back at our national "Sputnik moment," for example, when, at the height of the Cold War in 1957, the Soviet Union launched the first earth-orbiting satellite. That success, with the Sputnik probe, jarred Americans out of their complacency, underscoring both the threat to our global role and the imperative for us to sink money and effort into science. Soon after, Congress and Presidents Eisenhower and then Kennedy launched and enthusiastically backed NASA; the nation made it an imperative to train more engineers and scientists. We embarked on the Space Race, in which the U.S. declared victory when we put the first man on the moon in 1969. While some may dispute the boons to patriotism provided by our space exploration, it is inarguable how this national campaign advanced science, engineering and technology; we reap the benefits daily, whether through light-weight materials, miniaturized electronics or even "space age" foods we consume.
In biomedical research, the world looks to America for leadership. But China makes great strides daily, as do Japan, Australia, Britain, France, Indonesia and Singapore. India, Europe and even Russia are boosting their life sciences research budgets. We have always trained foreign students, but before the terrorist attacks of Sept. 11, many of them stayed and worked in America. Since then, immigration rules have changed and most of the young people we train from abroad return to their homes. That's good for their native lands but a loss for us.
Ponder for a moment, however, what more painful position the United States might be in if, due to a lack of budgetary foresight today, we learn tomorrow that another nation has made a breakthrough to know decisively how and why cells run amok to cause cancer? Where will we be if the best and brightest who figure out the biochemistry of the mind aren't on or linked to our shores? What if we soon see that we must send some vast chunk of our national treasury across the waters to pay for life-saving and life-changing therapies unlocked elsewhere?
Certainly we remain at the fore of medical-scientific research, and, as a lifelong participant in the field, I have optimism that there's a global commitment by physician-scientists to fundamentals of our field -- that science is based on transparent evidence that can be shared freely and in processes and practices that can be repeated to reproduce promised results.
Still, as someone who came of age in an American century, especially in a time when post-Sputnik scientific advances rolled out marvel after marvel that has so improved our lives and our well-being, I can only shake my head, pick up my pen and implore my lawmakers to act with less partisanship, greater thoughtfulness and an even deeper concern for our collective health, and not just fiscally speaking. Congress needs to find its cuts elsewhere and to step up to support the NIH and even more scientific and medical research.
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