Physicians and politicians have a joint passion: They love a good debate. Medicine, like politics, involves arguing issues large and small. Another thing they agree on is that all want Americans to be healthy and our economy to be competitive (though they may disagree on the best way to get there). But ask almost any physician or politician about where the country’s most important medical discoveries are born, and they’ll point to the National Institutes of Health for spawning the science that led to them.
There is broad agreement across political aisles, medical labs, academic institutions, and pharmaceutical companies that if the United States is to bring the next generation of lifesaving medicines to patients and remain healthy economically and competitively, the NIH must be well-funded. Why, then, is the Trump administration so opposed to doing that?
In his proposed budget for fiscal year 2018, Trump provides $26.9 billion for the NIH. That represents a cut of more than $7 billion — a 21 percent decrease from the budget Congress just passed to fund the government for the rest of fiscal year 2017. It also wipes away the $2 billion increase that Republicans and Democrats in Congress recognized was urgently needed. Tom Price, secretary of Health and Human Services, made the case for those cuts during Senate hearings Thursday.
The administration argues that if pharmaceutical companies faced less regulation, they could apply the money saved to more quickly develop lifesaving medicines and fill gaps created by a smaller NIH budget. But at a recent White House meeting to discuss the NIH, leaders of pharmaceutical companies and university medical centers cautioned that our current level of innovation will not happen without federal investment in basic research.
They’re right. Basic scientific research conducted at the NIH and through grants awarded to academic institutions creates the basis for the transformative medicines that industry brings to millions of patients, from interventions that prevent strokes in young children with sickle cell disease to methods of engineering our own immune cells to attack tumors and beat cancer. The pharmaceutical and medical device industries are not prepared to conduct essential basic research to this degree. Without that, there is no foundation for tomorrow’s medical innovations.
Compromising this support for the NIH puts at risk our ability to find solutions to the health problems that plague Americans, disrupts an important part of the economy, and impedes a future generation of scientists from entering the field of medical research.
Here’s one example of the trail from basic science to a game-changing medical advance. Fifteen years ago, NIH-funded researchers identified the cause of a common form of leukemia called chronic myeloid leukemia. This type of blood cancer starts in the bone marrow and can spread to other organs. That discovery led to the development of Gleevec, the first targeted treatment for the disease. Before that discovery, only 15 percent of patients with chronic myeloid leukemia lived for eight years or longer. Thanks to Gleevec, 75 percent now live that long. Newer research suggests that the medicine works so well at keeping chronic myeloid leukemia at bay that patients may be able to stop taking it altogether.
The NIH also has a proven benefit when it comes to business. Every dollar in NIH funding generates an estimated $8.38 return on investment, supporting 379,000 jobs through the development of medicines and devices, surgical techniques, public health improvements, and other non-pharmaceutical applications of NIH-supported research.
The possibility of NIH budget cuts creates an uneasy mindset for future generations of scientists. If the best and the brightest who are considering careers in the era of modern medicine know that the research they’re passionate about can’t be funded here (years of flat NIH funding mean that just 1 in 5 grant applications are funded each year), it’s easy to see why they would abandon those projects or pursue careers outside the United States.
There has never been a time of greater promise for the bench-to-bedside translation of basic advances and making science count for patients with improved capabilities for diagnosis, prognosis, and treatment. And while physicians will keep arguing about the finer points of medicine, the next time they prescribe a new medication that improves the lives of their patients and their families, all will agree that the NIH made it possible.
Kenneth C. Anderson, MD, is president of the American Society of Hematology, the world’s largest professional society working to conquer blood diseases, and a hematologic oncologist at Dana-Farber Cancer Institute in Boston.
