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Fiscal Cliff Diving: Here's to the Pool!

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Cliff divers -- the literal variety -- do intentionally and with grace what Washington has been striving spastically to avoid: They go over the cliff.

There are two reasons why cliff divers may sail off into empty space with relative equanimity. The first is that they know how to dive, and thus their descent, barring calamity, is both targeted and controlled. It is not the haphazard, sprawling belly flop the fiscal cliff seems to signify.

But that is the lesser of the reasons why that flight from the cliff face may be expected to end well. The greater reason resides at the bottom, in a pool of water. In fact, it is the pool.

The pool has equally profound implications for the cliff that currently imperils our economy and bedevils our government, but for the balm of a temporizing remedy. In this case, though, it is a pool of money.

The average cost of bringing a new FDA-approved drug to market has long exceeded $500 million. That cost encompasses drug development, and the rigorous sequence of testing required to show both that a drug works as intended, and is suitably safe. Even despite the time and money the process requires, the outcomes -- as we all have cause to know -- are not completely reliable. Perhaps, then, the price tag should be even higher?

As for breakthroughs in basic biomedical research -- the kind that truly promise to change the human condition for the better, and engender Nobel prizes -- they may cost more, evolving slowly from an insight, through years of painstaking toil, to clinical utility at long last and great expense.

The point of which is: Not even a vanishingly small percentage of the tiny percentage of the richest people among us could even dream of funding such an effort personally. Almost no one who would stand to benefit from -- indeed, whose life might one day depend on -- a critical biomedical advance could afford to pay a fraction of its costs.

That vanishingly tiny sliver of the population that could do so is unlikely to, for a number of reasons. The timeline for nurturing biomedical breakthroughs exceeds individual patience. The identification of appropriate candidate projects requires expertise extreme wealth does not confer. And to whatever extent the super-wealthy might underwrite biomedical research, one may presume they would fund projects of personal interest, rather than those of greatest potential benefit to the population.

To which I say: Thank goodness for the pool! For that's what the aggregation of tax revenue used to subsidize the NIH, the CDC, and the FDA is. A pool of funds in support of critical work on which lives -- perhaps our own, perhaps those of people we love -- might depend. Work that almost no individual could support, and no individual would.

The obligatory spending cuts onto which a fiscal cliff dive would flop us all include huge reductions in the budgets for the NIH, the CDC, the FDA, and other federal health agencies. That might sound fine to you because it might mean you get to keep a bit more of your own money. It might sound good to have lower taxes. It might sound good until the day you need a treatment that doesn't exist -- because nobody funded its development. None of us is an island.

So hanging on to a bit more of our money might sound good until the day of reckoning, whenever and however it arrives, when our flight is ending and our landing becomes salient. At that point, we are apt to find ourselves wishing for... a pool.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org


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