Not long ago, a promising young doctor came to me in tears, alarmed about the future of his research career. I was chair of the psychiatry department, and he wanted some fatherly advice. He was conducting a potentially landmark study on early diagnosis and treatment to prevent schizophrenia, but due to sustained cuts in funding from the National Institutes of Health (NIH), he was scrambling to obtain grant support. Sitting across from me, he confided that he was unable to cope with the stress of conducting his research by day and moonlighting in ERs on evenings and weekends to support his family, not to mention the constant struggle to get grants. Finally, he revealed that he was abandoning his research to take a job with an international pharmaceutical company.
Our nation is facing an apocalyptic crisis in financing health care, and as a society, we've made irresponsible, irrational budgetary choices when it comes to biomedical research. As a consequence, we're inflicting damage on our biomedical research enterprise that will take years if not decades to repair.
Our major source of research funding, the NIH and National Science Foundation (NSF), have been held hostage in the political budget battles of Congress and the Obama administration. Since 2003 NIH has seen less than inflationary increases in its budget and reductions in the number of grants it is able to fund. Compounding that trend were the sequester cuts that went into effect in March 2013. NIH cut 5 percent of its budget ($1.6 billion) across all activities, resulting in significant reductions in the number of grants and the budgets of ongoing research projects. NIH Director Francis Collins commented that this was "the darkest year ever" for medical research funding. The $1.1-trillion spending plan that President Obama signed last week to finance the government through September sets the NIH budget at $29.9 billion. And while this represents a slight increase over the post-sequester NIH budget, it is down $714 million from the level approved by Congress for 2013, and from the $30.9 billion provided in 2012.
The harm is not limited to the public sector. Between 2007 and 2012 U.S. industry investment in biomedical research has declined by nearly $13 billion (9 percent) at the same time that Japan's investment in this sector has risen by more than 30 percent and China's has soared by more than 300 percent.
Investment in biomedical research is vital not only for improving health and quality of life but for its contribution to jobs, a stronger economy, and international competitiveness. Shortsighted decisions lead to greater expense, as well as lost potential for health improvements, reduced health care costs, and a stronger economy in the long run. Consider the significant contributions of research advances over the past century: the increase in life span and the associated productivity and savings in the cost of health care. During the past 40 years, mortality rates for childhood cancers have dropped by 66 percent as a result of early detection and treatment. Between 1968 and 2006 the death rates from heart disease decreased by 65 percent, and the death rates from stroke by 73 percent. Since the introduction of HAART medication combinations in the mid 1990s, AIDS-related death rates in the U.S. have dropped by 79 percent.
While there are always fluctuations in the economy and federal budgets, research requires long-term commitment and consistency to be effective. When we erode the research base that has been built up over the past several decades, we do more than just cause a temporary hiatus. Major research efforts can't be started and stopped in short order; it takes a long time to establish the facilities, infrastructure, and highly trained staff. It may take years, maybe even decades, for basic and clinical research to recover from the current cuts and divestment. If unable to secure funding for a next step in research, researchers like my colleague must abandon promising areas of investigation after significant investment of time and resources.
This is especially the case with brain research, which provides the scientific underpinnings for mental health care. Mental health has been in the spotlight lately due to violent incidents involving persons with untreated mental illness. Since the gap in our knowledge of mental illnesses is greater than in other diseases, the need for consistent and stable funding is more urgent. And if we think about the investments we are making in cures and improved treatments relative to the economic costs of mental illness including substance use disorders, the investment is very small. The cost of treating mental disorders in the U.S. is $90 billion a year, while the total annual NIMH budget (the NIH institute that funds the majority of research on mental illness) is $1.1 billion.
This makes no sense. It is what Jennifer Zeitzer of the Federation of American Societies for Experimental Biology called "budgetary insanity." When we fail to prioritize and protect critical national resources like our biomedical research enterprise, we jeopardize our nation's well-being and future.
Some of our most talented young researchers are leaving the U.S. for better opportunities in Europe and Asia, while others like my young colleague abandon promising careers and areas of investigation. NIH Director Collins remarked that we will never know what lifesaving discoveries scientists forced to abandon their research may have made. Let's hope that it is not too late to reverse this trend.
Follow Jeffrey A. Lieberman, M.D. on Twitter: www.twitter.com/DrJLieberman