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William T. Talman, MD Headshot

The National Health Debt

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Federal funding for research, the thing that has supported all six of this year's Nobel Prize winners in Medicine or Physiology and Chemistry, is drying up faster than a parched desert after a rain. Its continual deterioration provides a frightening view of our country's lost sense of priorities and makes me ponder who is going to assume leadership to get us out of this mess.

Yes, you will hear some in Washington remonstrate about having to bring the debt under control. However, addressing priorities like funding for the National Institutes of Health (NIH) while accomplishing debt reduction is often considered with one budgetary hand (or both) tied behind the back. You will also hear self-praise from Congress for its having doubled the NIH budget between 1998 and 2003; but in the last decade, funding for NIH has not come close to keeping up with inflation. Today, funding for research, if it can even be obtained, pays for considerably less research than it did 10 years ago. Not only has the NIH budget stagnated and lost substantial value, but also Congress has not even been able to approve a budget for NIH in a timely manner for each of the last several years. As a result, scientists cannot engage in long term planning. In fact, short term planning has been difficult unless the plan was to close the lab.

The situation seemed horrible; but, unfortunately, it turned out merely to be the calm before the storm.

Unlike scientists who strive to make discoveries despite financial hardships, some of our elected officials decided that, if they couldn't do their job, they'd just throw in the towel and activate sequestration. They did this with seeming disregard for the consequences. As a result of sequestration, an NIH budget that was already suffering lost another $1.7 billion in funding in 2013. Furthermore, unless someone recognizes the impending calamity and actually does something about it, NIH will lose a total of $19 billion by the end of sequestration in 2021.

Politicians responsible for those losses have little to worry about immediately, though history may not be so kind. Curiously, the nature of science is protecting Congress from condemnation in that it often takes 10 years after a discovery is made before a treatment results. Remember that HIV/AIDS swooped down on society in the early 1980s and that it took a decade of work before treatments were found. Also, keep in mind that many of the scientific findings that made treatment possible had occurred before the AIDS epidemic arrived. With the loss of NIH funding now, we can anticipate significant delays before new discoveries that contribute to cures will come again. Will anyone notice when our nation's leadership in developing treatments and cures or in winning Nobel prizes for Physiology or Medicine falls behind other nations that are pouring resources into their research enterprise, or will we just arrive at that point and have no idea how we got there?

With such a grim outlook, scientists who have contributed novel discoveries for years have called it quits. Their work has been reviewed by experts at the NIH and found to be highly meritorious, but it has been thrown out because there was simply not enough federal funding to support it. Brilliant young people, potential scientists, seeing the handwriting on the wall, are looking at other careers that offer more security. Even if things suddenly changed and we could recruit young people into science, those people would need to be trained. That means that after college they would face, at the very least, three years of doctoral training and after that, years of postdoctoral training before they could independently direct a research program. Some love science so much that they head to other countries that will support them. Some just leave the field. That loss of talent is compounded when you consider the young person who has received federal support for scientific training but will leave science before making any scientific contributions.

And then last week a bad situation got even worse!

Unable to pass a budget that would simply continue last year's budget failure, our elected representatives shut down the federal government. Even before sequestration and before the shutdown, the probability that a scientist's work would be funded had fallen to historically low levels, and those odds will likely only get worse in the foreseeable future. Currently, the NIH website, where grants are submitted, includes a warning that there is no one minding the store. Those that should be there have been furloughed. Thus, even if a grant were submitted today, it would exist for an unknown period of time in the darkness of Cyberspace.

Imagine: amongst those grants that sit in limbo and amongst the many meritorious ones that wouldn't be funded even if NIH were open for business, there could be a grant that could open the door to treatment of devastating diseases like Alzheimer's disease, Parkinson's disease, rheumatoid arthritis, cancers and inflammatory bowel disease. Leaving NIH inadequately funded, and now essentially closed for business, is clearly a wasted opportunity when you realize that NIH research has led to cures of some cancers and treatments for other diseases.

What does the situation mean to me personally? It means that it is more probable than not that, even after 35 years of NIH funding, I will fail in my next application for NIH funding, and my lab will close. It means that four people supported on my current grant will have to find some other job or will be out of work. Now that should certainly help our economy! The loss is compounded in that laboratory equipment, purchased through NIH funding for our research, will be discarded if no one else can utilize it. Vendors from whom critical supplies have been purchased will have lost yet another customer. This doomsday scenario is not hypothetical. It is actually coming to pass at universities around this country.

You may hear some claim that lost federal research dollars will be replaced by industry, which will step into the breach and fund research. That is not the case! In fact, NIH was formed under the Ransdell Act (named after Democrat Senator from Louisiana, Joseph E. Ransdell), after efforts to get philanthropists and industry to fund basic research failed. Basic research now, as it was then, is too risky to be a good business model. Even if industry were to fund such research, you can rest assured that it would focus on diseases whose treatments would be profitable.

Any argument that there is no place for federal funding of research is patently nonsensical. The argument should be abandoned immediately.

I can only hope that members of the public will contact their senators and representatives today to urge them to end the shutdown and to fund NIH and other federal research agencies with increased funding for 2014. Scientists, friends of science, and those who benefit from the scientific discoveries can easily make their voices heard.