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March 20, 2007

Priorities

This is crazy:

Representatives from a consortium of major medical and scientific institutions testified at a Senate Appropriations Committee hearing on Monday that a lack of funding for grants at NIH has stymied scientific research, the Washington Times reports. In previous years, the federal health agency's budget typically increased by 15%. It grew by 2.5% in 2004, 2% in 2005 and one-tenth of 1% last year, for a total budget of $28.3 billion. The fiscal 2007 budget has yet to be released, but an increase of eight-tenths of 1% is projected for 2008, according to NIH figures. The researchers testified that NIH's recent funding levels have caused about eight out of 10 research grant applications to go unfunded and researchers to spend more time applying for grants than studying treatments for diseases.

I don't even know what to say. The NIH is, by all accounts, a remarkably successful government institution, and the research it funds has a proven track record of advancing science, spurring new treatments, and saving lives. And that doesn't even address the economic benefits of supercharging America's pharmaceuticals and biotechnology industries. But we're now slowing it's growth down to less than one percent...and for what? The war in Iraq? Deficit reduction?

Let's just be clear on this. Democrats, you listen up too. You do not reduce the deficit by defunding innovative research in growth industries. That's shooting yourself in the in the hip to spite your wallet.

March 20, 2007 in Health and Medicine | Permalink

Comments

Uhhh ... some of this is spin. The Clinton administration embarked on a long expansion of the NIH budget. The Bush administration, laudably, continued to expand NIH. "In previous years", the NIH budget was rising under scheduled expansions, which have now run out.

Now, obviously you can make the case that we should keep expanding NiH, but the status quo of 15% increases every year will become untenable at some point.

Posted by: Nicholas Beaudrot | Mar 20, 2007 5:13:30 PM

What about NSF and EPA and other research operations. Also, how are the NIH cuts distributed..or are they? Is it something to do with abortion/voodoo medicine or are the cuts across the board?

Posted by: Mudge | Mar 20, 2007 5:43:24 PM

Amen to that. The NIH = American Science. Every lab at every university relies on NIH money for research. If the NIH is cut, then American science and innovation will decline EXPONENTIALLY.

Posted by: Jason | Mar 20, 2007 5:46:30 PM

I'd get on board with a slight slow-down of NIH's budget growth if we'd reallocate the rest of the dough to AHRQ.

Posted by: Adrienne | Mar 20, 2007 6:23:24 PM

This is garbage. You cant fund the NIH at a 15% increase EVERY SINGLE YEAR.

This is more ridiculous liberal hyperbole. Because a program didnt get the same increase in funding that it did last year, its called a "budget cut".

Its ridiculous logic.

BTW, if the NIH wants more money maybe they should quick funding quack projects like all the "alternative medicine" bullshit going on over at NCCAM. Its a horrible use of taxpayer money.

Another priority should be diversion of funds away from HIV to other areas. HIV gets a hugely disproportionate supply of funds for a disease thats 99% preventable and for which we already have tremendously effective drugs.

Posted by: joe blow | Mar 20, 2007 6:29:56 PM

Actually, Joe, increasing funding for the NIH at 0.8% is taking money away from its overall budget. General inflation is currently just over 2% per annum. Thus a budget increase of less than that reduces the NIH's spending power.

Posted by: Sam | Mar 20, 2007 6:51:51 PM

If I recall correctly, NCCAM wasn't really hit by the cuts. According to this they have a much more liberal payline than the rest of the NIH. Apparently Bush can cut actual science, but we can't stop learning about homeopathy, faith healing, Reiki therapy, and other such bullshit. Typical.

Posted by: Cain | Mar 20, 2007 7:09:18 PM

joe blow,

that's actualy kind of funny, I have a grant curently under review at NCCAM (second year neuropharmalogical grad student) looking into the effects of EGCG (one of the main components of green tea) on spinal cord injury. It's been shown that EGCG can lead to nerve regrowth after spinal cord injury in rats and we have a couple of theories about which enzymes it targets. Useless science, hunh? But yeah, I and many in the scientific community disagree with their funding priorites, which is why over the past three years they've been shifting towards harder science. As for not funding HIV research, that proves you're an idiot. You have any idea how many millions are infected? What other diseases should that money go to?

Cain,

that link is killing me, I got a 188 and I'm still waiting another month to hear the final word on funding. Basically for a grad student it means a 30% raise. I don't expect to get it on the first submission (I get a resubmission) but it would be amazing.

Ezra,

obviously they can't increase 15% every year, but as others have pointed out we're below inflation, which is a real cut in purchasing power. Anyone who disagrees this is a problem can get me to shut up by pointing to a drug therapy that doesn't have it's roots in government funded science. I dare you. You won't win. The reason we've dominated in science for the last century is through well funded public universities making breakthroughs that are then developed and refined by private industry. One won't work without the other.

Posted by: slapshot57 | Mar 20, 2007 8:32:30 PM

NCCAM is an excellent use of funds. Alternative medicine is a huge industry in this country that is sometimes used as a substitute for more scientific medicine. Submitting the claims of alternative medicine to scientific scrutiny will save money, health and lives in the long run.

Posted by: Sanpete | Mar 20, 2007 8:39:57 PM

I'll interject a perspective from a longtime researcher who has funded his research primarily via NIH. The problem with the 15% per year during Clinton to the near zero today under Bush is not that we or anyone else expects 15% per year increases. Rather, the very sharp pull back in funding creates a funding whiplash because grants that are funded in 2007 for example, typically run for 3-5 years. Thus, each awarded grant encumbers a proportion of future money. Money for new grants each year come essentially from grants that have run out and from budget increases. New grants are critical to young researchers. The current situation is one of the worst case senarios for how you fund research. That is, fund lots of new grants (during the 15% increases), and now essentially freeze the budget. In previous years, if your grant was scored in the top 20% of all grants, you were likely to get funded. These days, the lack on funding increases means that the pool of money for new grants is such that you must score near the upper 10% for many of the institutes (e.g., National Institute of Mental Health grants have flirted with an 8% payline).

NSF funding, while always difficult, has faired a bit better although my knowledge of this is more limited.

Researchers understand that funding is in the mix of priorities along with everything else, we're not looking for more 15% increases. But, the damage of the current situation is real. I have seen laboratories severely curtail their work, and the researchers go from writing 2 or 3 grants per year to 6-7 per year. This isn't productive, it generates alot of work for everyone, and draws us out of the laboratory where we would normally be doing much more productive work.

Realistically, 6-8% increases per year for a few years would help immensely.

Anyway, those are my two cents. I have to go work on a grant now. (seriously...)

Posted by: Glockenspieler | Mar 20, 2007 8:52:01 PM

I have to echo what everyone else said, except for joe blow. Another thing about researching "alternative medicines" is that "traditional" remedies like herbs and other things alleged to have positive health advantages can't be patented-- therefore, the private sector has little incentive to do the research themselves. Rigorous scientific testing can determine which remedies are old wives' tales and which are actually efficacious.

That said, let me just mention one of the consequences of increasing NIH funding-- with more funding, professors hire more graduate students. With more graduate students finishing, professors can hire more postdocs. Positions that can't be filled by domestic Ph.D.s can be filled by finding people with Ph.D.s abroad. With all of these newly trained scientists, there are still a relatively static number of professorships available, and the market is now much tighter.

I am a scientist, so you'll hear nothing but support for greater NIH and NSF funding from me, but someone on the science policy side needs to point out that we need to think about long term career prospects for scientists. In the biological sciences, the prospects are relatively low paying and the financial rewards of success are relatively modest. I know that one party isn't too interested in science policy, and I'd like the other to start thinking about it a bit more.

Posted by: Constantine | Mar 20, 2007 10:15:55 PM

Yeah science positions are low paying in academics. So what? If you dont like it, we'll find a foreigner to fill your spot. Foreigners will gladly come to the USA for a pissant 50k salary even if they ahve 5 PHDs already.

USA takes in more foreign scientists than all other nations COMBINED so if the homegrown americans dont like it, we'll gladly substitute them for a foreigner.

Posted by: joe blow | Mar 20, 2007 10:58:37 PM

"As for not funding HIV research, that proves you're an idiot. You have any idea how many millions are infected? What other diseases should that money go to?"

I never said eliminate it entirely, but its clear that HIV gets far more funding thats not justified based on mortality statistics because of all the flaming gay liberals who use hyperbole to describe the govt as a death squad if they dont get their billions every year.

HIV is a preventable, chronic disease. The meds we have now are essentially lifetime maintenance drugs. If you eliminate those who either couldnt afford the drugs or decided not to take them because of side effects, the number of HIV deaths since 2000 falls down somewhere between #20 and #25 of the most deadly diseases, depending which source you use.

Heart disease and cancer kill MILLIONS more people every year than HIV, and furthermore our treatment options for both categories of disease SUCK ASS. So yes, pardon me if I think more funds should be diverted in those directions.

Posted by: joe blow | Mar 20, 2007 11:04:13 PM

USA takes in more foreign scientists than all other nations COMBINED...
Is this true? I would like a link if you have one handy.

Posted by: Fred Jones | Mar 20, 2007 11:04:49 PM

Yeah science positions are low paying in academics. So what? If you dont like it, we'll find a foreigner to fill your spot.

Gee, thanks for repeating exactly what I said.

Foreigners will gladly come to the USA for a pissant 50k salary even if they ahve 5 PHDs already.

One would be hard-pressed to find a professor in the biological sciences willing to splurge on a 50k salary for a postdoctoral fellow. However, if you know one paying that much, please give me his number, as my friends wouldn't mind getting a raise.

This is one thing I find irritating about those claims that, "not enough people are going into science! we need more scientists!" Well there's a reason not many people are going into science-- it's not that great a job. Smart, motivated students at the top of their class can find better opportunities in investment banking, management consulting, law, and medicine. If you do succeed and become a professor, you get the privilege of spending your life scrounging for an ever-shrinking pool of research funding. This story from last January drove home the point:

Researchers in nearly every field are finding it harder to win competitive grants from the National Institutes of Health, the National Science Foundation, and other research agencies. But those hurt most by the ultra-competitive climate, say academics at MIT and elsewhere, are young researchers who are just starting their studies or their careers.

...

Last year, two researchers turned down job offers from MIT’s physics department and went to work instead in Europe, where funding is less of a struggle.

“It was quite striking,” said Marc A. Kastner, who heads the department. “It used to be that a position at MIT was the best in the world, and now people are turning us down.”

Posted by: Constantine | Mar 20, 2007 11:33:41 PM

I have worked in bio-medical research for about 5 years, it seems that many of the people in the field are not smart enough to be doing medical research. Maybe it is that the really smart people go into other fields where they can make more money, leaving the medical research to the dull tools. This isn't true for all of the people doint the research but many of them, so maybe it would be a good thing if the NIH was a little more selective at to what they fund.

Posted by: bryce | Mar 21, 2007 12:35:58 AM

so maybe it would be a good thing if the NIH was a little more selective at to what they fund.

The average age of a first award of an NIH grant for a researcher with a Ph.D. is 42. Given this, I find it difficult to believe that NIH, which is approving less than 1 out of 5 grant applications only to award them to people with 10-15 years of post-PhD research experience, isn't being "selective" and is somehow choosing people who aren't smart. (though maybe you're referring to the postdocs and Ph.D. students, of course)

Posted by: Constantine | Mar 21, 2007 8:00:40 AM

re the CAM stuff, of course this crap is patentable. A new use for an old product gets you a new patent. People are making millions peddling this snake oil, there definitely is a profit motive. The reason drug companies don't make this stuff is because they're under FDA-imposed restrictions requiring proof of efficacy. Companies that make herbs, homeopathic remedies, supplements, and the like are under no such restrictions.

I think the term "alternative medicine" presents a false picture; there is only medicine and not medicine. If there's science behind it, it's medicine. If there's only anecdotes and spirituality, then it's not.

Alties are like 9/11 conspiracy theorists. No amount of evidence to the contrary is going to convince these people, they just know it works. Our limited government research dollars should be going towards projects that advance our scientific and medical knowledge. We shouldn't lower the bar just so we can test stuff that's scientifically improbable or impossible.

Posted by: Cain | Mar 21, 2007 11:46:57 AM

Cain, all that I've heard about patent law implies the opposite of what you say, that green tea, for example, cannot be patented for some particular use in any practical way.

Drug companies aren't under any FDA restrictions about efficacy of use in regard to herbal products.

It's you against the dictionaries in regard to what counts as "medicine."

There are many people who do follow the scientific outcomes for alternative medicine. If the FDA oversaw alternative medical products, they would have to shown to be efficacious. Having another agency do some of that much needed work is a good thing. There is no lowering of the bar. The most used or seemingly promising remedies are those tested first, which is perfectly sensible.

Posted by: Sanpete | Mar 21, 2007 12:24:48 PM

Sanpete, you might want to check out 35 USC 101, which reads:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.

Secondly, what are you talking about? Drugs need FDA approval to go to market, and that approval requires safety and efficacy testing in randomized, double blind, controlled trials. The only reason any alternative medicine can be sold is because it's not subject by statute to this process.

Ooh, you threw a dictionary definition at me. Horrors. Ok, let's go to the Webster's dictionary then:

1 a : a substance or preparation used in treating disease b : something that affects well-being

Since alternative medicine doesn't affect disease or well-being, I would say it falls outside this definition. If any of these therapies or herbs or whatnot is shown to have healing qualities, then it just becomes "medicine", no qualifier is needed.

There have been numerous studies throughout the years disproving the claims of CAM practitioners. This has not done one iota of good in stopping people from believing in them. In addition, NCCAM doesn't have the power to stop CAM products from coming to market, which is a power the FDA has over real medicine, so your analogy is false.

The only evidence given for these "promising" remedies is usually anecdotal or faith-driven. I see this as a lowered bar when compared to experimental oncologists working on a cancer cure or HIV researchers, who give complex grant applications full of preliminary data hypothesis that exist in the world of possible science.


Posted by: Cain | Mar 21, 2007 3:13:08 PM

Even if you were correct-- say a pharm company COULD patent the use of green tea as a treatment for, say, the flu, if it were proven that St. John's Wort were scientifically proven to reduce depression, then, no, a pharm company couldn't patent it. Why? Because of prior art-- someone had already thought of the idea before, so it's not original and thus not patentable.

There is no way that any "traditional" remedies could be patentable if they were scientifically proven to work simply because the idea already exists (one could probably patent an original delivery mechanism, much like innovations in toothpaste tube design can be patented).

Posted by: Constantine | Mar 21, 2007 3:20:39 PM

I have a different view from most of the posters and Ezra. NIH is wildly overfunded. The NIH budget doubled from 1998 to 2003. Did the number of outstanding grant proposals double in that time frame? I doubt it.

I'm a liberal, I'm a Democrat but, as I've said before, I work on Health Policy. From my vantage we spend way too much on research developing treatments for diseases that could be prevented if people could just get care early. There was a great article in the Post about a year ago on this subject: Unhealthy Medicine, ll Breakthrough, No Follow-Through

The federal government invests billions of dollars in this enterprise, and competition for better products drives the highly lucrative pharmaceutical and medical device industries.

But the promise of a cure requires an additional step: Patients must receive the treatments promptly and properly. This step requires a well-functioning system to deliver care, which our country lacks. We spend far more money on inventing new treatments than on research into how to deliver them... Starkly put, for every dollar Congress allocates to develop breakthrough treatments, it allocates one penny to ensure that Americans actually receive them.

It would be nice if we had an infinite budget and everything could be funded, but we don't. Politicians love to go home and tell their voters how much they gave for treatment research. For some reason prevention doesn't rank up there and let's not even mention the uninsured. NIH gets too much money and the CDC is woefully underfunded. If you want to get outraged look at their facilities. I don't cry for NIH because I see how much they have and how little goes to prevention and making sure the wonderful discoveries get to poor people who need them.

Posted by: SteveH | Mar 21, 2007 3:45:34 PM

Cain, what you quote from the US Code doesn't conflict with what I said. Green tea cannot be patented. In addition to what Constantine pointed out, even if you were to get a patent for some special use of it, how would you enforce it? Everyone can get green tea sold for ordinary drinking and use it for their own private, noncommercial purposes, where patent protections are both weakest and impossible to enforce in any practical way.

Herbal products aren't drugs for the purposes of the FDA. Any drug company can produce and sell them without any interference from the FDA.

You apparently didn't read your own dictionary definition correctly. Obviously alternative medicine is used to treat disease, in keeping with the first definition.

You're just wrong about the effect of the scientific study of alternative medicine. Studies on the efficacy of echinacea, for example, have been widely reported, and I know for a fact that it has changed the behavior of some people. You seem to think that everyone who is attracted to alternative medicine os some kind of anti-scientific moron. You're just flat wrong.

Yes, the government lacks the authority to ban alternative treatments for lack of efficacy, but they can and do ban them for harmful effects. You attempted to make too much of the analogy to the FDA.

There is no lowering of the bar in how science is carried out on studying alternative medicine. You haven't show or even suggested any. It's just as useful in practice to test popular treatments, so they can be eliminated if they don't help, as to test ones that are promising for some scientific reason.

Posted by: Sanpete | Mar 21, 2007 4:25:42 PM

SteveH:

You quoted the Post as saying:"Starkly put, for every dollar Congress allocates to develop breakthrough treatments, it allocates one penny to ensure that Americans actually receive them."

But how about Medicare and Medicaid? Those together are the largest component of the federal budget, totalling some $0.5 trillion per year and rising fast.

I guess I do not understand your complaint.

Posted by: pzw57 | Mar 21, 2007 4:26:45 PM

If you don't understand the excerpt, click the link and read the article. Even with Medicare and Medicaid we have 47 million uninsured. For many insured, the costs of some treatments are so high they still can't get them. And many effective treatments go underused because actually dispersing information on them isn't considered as important as dumping money into NIH.

Posted by: SteveH | Mar 21, 2007 7:34:59 PM

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