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US Biomedical Research: We Must Reverse a Decade of Neglect

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As an HIV physician, I began my career early in the AIDS epidemic before effective antiviral medications existed. I held my patients' hands as they cried when receiving their diagnosis and I went to their funerals. I saw hope in their eyes when new antivirals became available. And when protease inhibitors were licensed and "triple therapy" became the norm, I could help patients plan how they would live, rather than how they would die. Scientific breakthroughs happened only because of our nation's commitment to biomedical research, but this power of research to make lives better is at great risk.

The decline of U.S. prominence in global biomedical research is upon us: The National Institutes of Health budget has been flat for 10 years and lost 25 percent of its purchasing power, sequestration cut $1.7 billion from the 2013 NIH budget and the 2014 budget is $714 million less than the level approved for 2013, the federal government shutdown prevented enrollment of patients into clinical studies and delayed clinical research protocols, and next generation researchers are taking ideas and talents to other countries. The U.S. sits on the sidelines as nations such as China and India increase research investment by nearly 20 percent while the U.S. drops by 5 percent.

The government's failure to ensure significant ongoing support for biomedical research undermines the future of science and health in our nation and threatens a strategic driver of the economy. The call to action is clear: The research community must increase advocacy, develop novel research partnerships, and create new opportunities for young researchers.

Sustain Recently Increased Advocacy

Attacks on the biomedical research enterprise during the past year catalyzed an inspirational increase in advocacy. It is now the research community's responsibility to itself -- and the nation -- to maintain, if not increase, that momentum. For example, more than 200 university presidents collaborated through the Association of American Universities and the Association of Public and Land-grant Universities to sign a letter to President Obama and Congress stating, "Closing this innovation deficit -- the widening gap between needed and actual investments -- must be a national imperative."

Professional associations provide valuable advocacy activities, yet we cannot rely solely on their programs. Scientists and health professionals must come out of laboratories and clinics to individually advocate for research. With our own voices, we must tell the great stories of biomedical research to communities, business leaders and elected officials, and raise our concerns to the media and all virtual venues of public opinion. We must explain science in ways that galvanize widespread support for investment.

Investigate New Approaches to Research Collaboration

Scientists and funders must embrace a transformational culture of collaboration that brings together academia, industry, philanthropy and government in new partnerships. After more than two years of preparation, the NIH, FDA, 10 biopharmaceutical companies and eight nonprofit organizations launched the groundbreaking Accelerating Medicines Partnership to expedite the discovery of medicines for Alzheimer's disease, type 2 diabetes, rheumatoid arthritis and lupus. A game-changing component is that the data and analyses generated will be publicly available to the biomedical community. The GlaxoSmithKline-led Oncology Clinical and Translational Consortium links six cancer centers around the world in a model that helps address traditional obstacles between academia and industry and competition among academic research entities. Many nonprofit disease-focused research foundations serve as broker-catalysts to coordinate academia and industry, including the Leukemia and Lymphoma Society which formed Beat AML (acute myeloid leukemia) that connects researchers from four universities with computational analysis from Intel Corporation and genetic sequencing from Illumina, Inc.

Invest in Next Generation Researchers

And we must cultivate the next generation of scientists. New investigators rely on NIH grants to help launch careers and engage passion for discovery, yet the outlook is discouraging: Investigator-initiated R01 grants annually awarded by the NIH dropped 27 percent between 2003 and 2012, reflecting an all-time low success rate of 18 percent in 2011. Unsurprisingly, principal investigators who are 36 years of age or younger dropped from 18 percent in 1980 to 3 percent in 2012. The U.S. squandered a decade of opportunity to increase NIH funding -- the nation must not compound that deficit by losing the next generation of researchers. In one innovative solution, the Albert and Mary Lasker Foundation participates in a unique NIH partnership that provides up to 11 years of support for early-career investigators. The entire research community must step up and collaboratively create new opportunities to invest in future leaders of research.

Speak Up for the Future of Health

Research can thrive only with a national commitment to long-term adequate funding that transcends partisan politics and daily crises. The nation's dedication to biomedical research determines our ability to restore, protect and advance the U.S. as the home for scientific achievements that create hope and better quality of life. Elected representatives must support biomedical research; it is the best investment in the country's future. We must ensure sufficient funding to continue to battle HIV and find answers for those with cancer and diabetes and schizophrenia -- indeed, all the causes of suffering, disability and death in the U.S. and around the world.