Vantage point: Budget pressures jeopardize future of medical research

Dean Philip Pizzo

At the turn of the 21st century, the government doubled the National Institutes of Health's budget with the goal of securing its status as the most powerful medical research enterprise the world has ever seen.

But later this month the House of Representatives could shed light on the government's vision for the future of this agency—the driving force in the nation's effort to find cures for cancer, heart disease and scores of other maladies. After the chamber returns from recess on April 25, efforts will be made to have the House consider a budget resolution that addresses the agency's funding. How these efforts proceed will signal whether a troubling budget trend has emerged: the "undoubling" of the NIH.

The NIH has been at the forefront of developing the panoply of vaccines that has prevented serious illnesses. It has helped to realize new treatments that have reduced mortality rates from heart disease and strokes by 40 percent and 51 percent, respectively, since the late 1970s. In the last year, at Stanford University School of Medicine alone, NIH money has helped to make possible a vastly improved way to do stem cell transplants for curing leukemia, the development of a new class of drugs for treating the symptoms of rheumatoid arthritis and the identification of a gene that could help doctors pinpoint and begin treating children at risk of schizophrenia before symptoms appear.

And that barely scratches the surface of the NIH-funded work that is taking place at Stanford and across the nation.

Unfortunately, after several decades of increasing NIH budgets—under both Democratic and Republican presidents—the current leadership in Washington has reversed this course. In this year's budget, funding for the NIH was cut for the first time in more than 30 years, and the administration's budget proposal for next year would freeze the NIH budget at that level. The amount provided next year to two of the NIH's biggest institutes, the National Cancer Institute and the National Heart, Lung and Blood Institute, would be cut by $40 million and $21 million.

The bottom line: the budget proposal would give the NIH 13 percent less, when adjusted for inflation, than the one it had in 2003, the end of the five-year period in which the budget had been doubled.

While the NIH's funding remains substantial, our research systems are fragile. A loss of support can quickly begin to unravel our progress, particularly as other nations launch unprecedented research initiatives. Vast new research programs have been built in China, Singapore and India, as well as in Europe. Talented bioscientists and trainees who once considered the United States the only place to conduct their work now have other options. Over the last few years the tiny nation of Singapore, for instance, has successfully recruited three of the National Cancer Institute's most senior scientists with its commitment to long-term funding and its spacious, state-of-the-art laboratories.

Even more disturbing is that the pipeline of new talent to succeed these and other established scientists will be jeopardized as research funding becomes less available. It's already apparent that the growing challenge of obtaining NIH funding is sapping the morale of many in the field. The competition for grants has become brutal, with fewer than one in 20 applications winning approval. This year the number of new grants funded by the NIH is projected to drop by almost 15 percent from the number funded three years ago.

This increased competition for scarce resources isn't going to lead to better science. If the NIH dollars become tighter, it will become less likely that innovative ideas will flower. The best and brightest of our researchers will be less willing to take risks for fear of not being funded. Consequently, they may turn to more predictable, "safer" funding proposals, potentially missing the opportunity for major breakthroughs.

The effect of underfunding on research is well-illustrated by the challenges the nation now faces in the physical and engineering sciences. There is widespread concern that we are losing our competitive edge in fields in which we have long been leaders. To the president's credit, he has championed the American Competitiveness Initiative to enhance support in these areas.

But it would not be in the national interest to create the same problem in the biosciences that we are now seeking to address in the physical sciences—especially at a time when the great advances of the future are likely to be found at the intersection of physics, engineering, computers and biology.

I certainly understand that federal dollars are a limited and precious resource, but the NIH's efforts cannot be measured strictly in annual budget cycles. Growth in funding must be sustained if we are to avoid undoing the foundation that has been so carefully laid. Fortunately, a number of legislators share that perspective. Under the leadership of Senators Arlen Specter (R.-Pa.), Tom Harkin (D.-Iowa) and both Diane Feinstein and Barabara Boxer, the Senate approved a resolution recommending adding $2 billion to NIH, bringing its budget to about $30 billion. It is this resolution that may be brought before the House later this month.

The vote is just one step in the budget deliberations, though for medical scientists it will send an important signal. Will the Congress remain steadfast in its commitment to research endeavors that can span decades but which offer the prospect of cures for future generations? Or will the NIH fall prey to a funding cycle that demands immediate gratification and instant results, thus losing sight of the future health of our nation?

Philip Pizzo, MD, is the dean of the School of Medicine. This column is adapted from his op-ed piece that appeared in the April 4 issue of the San Jose Mercury News.