US Federal Government Shutdown Freezes NIH Operations

Yes. You read correctly. The United States Federal government entered a shutdown on October 1, 2013 and for 17 days. The first question that came to my mind “Can they even do that?”. Believe it or not, yes they can! Setting aside the complex political fight behind that (generally because of President Obama healthcare law, aka ObamaCare), let me walk you through what relates to us; biomedical researchers.

Photo credit: originally published on Cambria Press

The Washington Post estimated that 800,000 federal employees were indefinitely furloughed. However, 1.3 million "essential" federal workers, 1.4 million active-duty military members, 500,000 Postal Service workers, and other employees in independently-funded agencies were required to report to work with no expectation to receive their salaries.

As a result, the NIH released a statement that all its operations, including grant submissions, reviews and funding, have been suspended due to the lapse in federal funding. The NIH resumed its operations on October 17, 2013.

This reminds me with an editorial published in JAMA earlier this year by Dr. Ezekiel J. Emanuel, Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Dr. Emanuel predicted within the lines of his editorial what we face now.

Dr. Emanuel summarizes four factors that contribute to the “erosion of support for the NIH”. These include:

• First, politicization of science by losing the bipartisan agreement that long existed in the US.
• Second, disappearance of strong Congressional champions of the NIH, most importantly, John Porter (R, IL – Retired), Arlen Specter (D, PA – Died), and Ted Kennedy (D, MA – Died).
• Third, the congress may have thought that NIH funding has been sorted out after the 2003 doubling of its budget.
• Fourth, the continuous increase in the US federal budget deficit over $1 trillion makes the case harder to justify that NIH funding for biomedical research should be a top priority.

Dr. Emanuel proposes three solutions that could improve the dire NIH funding situation.

• First, pro-NIH congressional members need to be identified, educated, and cultivated, to lead the fight for increasing funding for biomedical research.
• Second, researchers have to do a better job of explaining the value of biomedical research, and stop promising cost reductions.
• Third, physician researchers should focus on efficient delivery of patient care, rather than just increased profit from clinical services. This will make the health-related expenditures must stop increasing faster than GDP, allowing more room to ask for more NIH funding.

 The editorial closes with:

“Most importantly, the NIH and the larger biomedical research community need to direct their considerable talents and resources to developing biomedical technologies that are not just “incredibly exciting” but also cost lowering and value enhancing. Many tremendous triumphs of NIH research, such as the Haemophilus influenza type B vaccine, did just that.”

Well, This says it all!

More on Funding of Biomedical Research

In this post, I tap on a burning issue that is immensely important to people like me who are working full time in biomedical research; funding. Despite the hurdles it faces to improve care, clinical medicine generates direct income (and profit) through the patient care it delivers. Such income pays physicians, nurses, hospital teams, overheads etc… Unlike clinical medicine, biomedical research is mechanism that requires tons of money, but it is always viewed as a national investment for future economic growth.

The National Institutes of Health (NIH), the largest funding organization of biomedical research in the world, describes the impact of its work on US economy, and states that:

It directly supported almost half million jobs in medical research in 2012
For every $1 of NIH funding, about $2.21 is generated in local economic growth.
Let’s look at just one example. The U.S. government’s $4 billion investment in the Human Genome Project spurred an estimated $965 billion in economic growth from 1988-2012; a 178-fold return on investment, after adjusting for inflation.

NIH isn't the only US governmental agency that funds biomedical research. Other major agencies include Department of Defense, Department of Homeland Security, and Department of Agriculture, among many others.

However, who decides the dollar amount to be spent by these agencies is the legislative arm in the US; the Congress. Due to the major budget cuts in 2010:

NIH budget was decreased by ~14%
Department of Defense budget was decreased by ~12%
Department of Agriculture budget was decreased by ~20%
What is very shocking is that the Department of Homeland Security budget for biodefense was almost shut down, and decreased by ~91%.

A striking example showing the projected difference between healthcare spending on Parkinson’s Disease versus the research and development (R&D) spending on Parkinson’s Disease is shown in the below figure. While the current funding limits are maintained, the healthcare cost of the 1.5 million Americans with Parkinson’s Disease, with annual incidence of 60k new cases, will jump from $8 billion to $18 billion per year. 

Figure adapted from 10th annual Investment in Research 2012 report by Research!America.

Federal spending on R&D doesn't only support direct biomedical research in the US. In addition to support training programs (predoctoral, doctoral, and postdoctoral levels) and research centers, it also supports research globally through USAID and the NIH’s Fogarty International Center.

More detailed figures can be found in 10th annual Investment in Research 2012 report by Research!America. 

Does Epidemiology Matter?

Dr. Michael Lauer, the director of the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), recently wrote an editorial in JAMA¹ calling for “creative transformation” of epidemiology research in the United States.  He states:

“…Yet today, despite these extraordinary contributions, the value of epidemiology is questioned. Critics cite excess expense, repudiated findings, studies that offer small incremental knowledge, inability to innovate at reasonable cost, and failure to identify research questions with the greatest merit. At a time of unprecedented budgetary constraints, these critics wonder what epidemiology has done for medical science lately…”.  

Dr. Lauer's comments are crucial especially with the recent budget sequestration to limit United States' federal spending to meet the deficit targets that will likely affect the already decreased funding medical research from the National Institutes of Health (NIH). NIH Director, Dr. Francis Collins, MD, PhD, stated that the NIH already lost 20% of its purchasing power for medical research. Furthermore, such cuts will force the NIH to fund 2300 fewer grants in 2013. Such automatic cuts will be "devastating". Of course I don't have to mention the accompanying economic crisis worldwide. 

Dr. Lauer sums the needed actions into the following key elements:

“… Such transformations will likely include refocused scientific questions, centralized and integrated governance, different types of exposure and outcome measures, and embedded clinical and policy trials…”  

The driving passion behind initiating this academic epidemiology blog is to discuss the latest findings from epidemiologic research of mainly non-communicable diseases that would be of interest to epidemiologists, epidemiologists-in-training, and practicing physicians. Our main focus will be directed towards discussing groundbreaking findings that affects clinical practice, policy-making and lifestyle. 

Dr. Lauer concluded his JAMA editorial: 

“These transformations will also ensure that epidemiology will have much to give, whether lately or later.”

I am sure we will!


References:

1.       Lauer, M. S. (2012) Time for a creative transformation of epidemiology in the United States.   JAMA 308, 1804-1805