The way forward for U.S. health care is research -- not just for the benefit of patients, but as an engine for economic growth.
This time of year, trainees make the rounds to interview for graduate programs, medical school, and residency or fellowship positions. In many cases, they spend a decade or more after college before they can move on to independent careers in academia or industry. As a director of the Physician Scientist Training Program at Northwestern, my discussions with these young men and women invariably turn to their plans for the future, their much-deserved opportunities to practice their trade for which they have been so thoroughly trained, and the challenges they might face in research. But this year I try not to go there. This year the fiscal cliff looms
If the U.S. Congress fails to act, the now clichéd across-the-board tax cuts on discretionary spending -- the so called "sequestration" clause of the Budget Control Act of 2011 -- will kick in. One might argue that this could trigger a recession; but there is almost no denial that it will cripple U.S. scientific enterprise.
The sequestration will cause an approximately 8 percent cut in funding for federal research agencies. This includes the National Institutes of Health, the National Science Foundation, the Food and Drug Administration, the Department of Energy, National Aeronautics and Space Agency, the Environment Protection Agency, the National Oceanic and Atmospheric Administration and the U.S. Geological Survey. These do not even take into account the proposed cuts in research spending by the military.
Scientists everywhere are worried. Federal agencies do not just fund science in their own institutes; through their extramural programs they provide grants to investigators in universities and medical schools across the nation. No private foundation or corporation even comes close in providing this magnitude of research support. Scientific communities such as the Society for Neuroscience, the Federation of American Societies for Experimental Biology, the American Society for Cell Biology and others are aghast, urging their members to speak out.
As a physician-scientist, I am most familiar with biomedical research. In this arena, scientists have been having a tough time obtaining research support already: funding from the National Institutes of Health, also known as the NIH, that funds this sort of research has been static at around $31 billion for the last decade; indeed falling in comparison to inflation by approximately 20 percent.
This has made it very difficult for scientists to compete for the diminishing pot of money. The odds of a new proposal being funded have reduced precipitously, by almost half.
This has taken a steady toll on careers. Established scientists have had to down-size their research programs; younger, less-established investigators are essentially straggling along with shoe-string budgets, or quitting the field. University leaders are aware of the implications.
Indeed, this month, the presidents of three Illinois Universities -- Northwestern University, University of Chicago and University of Illinois -- have appealed in a joint letter to Senator Dick Durbin to spare scientific research funding from the guillotine.
In their letter, Morton Schapiro of NU; Robert J. Zimmer of The University of Chicago; and Robert A. Easter of the University of Illinois, wrote that these schools have "received more than $1 billion in research funding from the National Institutes of Health and the National Science Foundation last year alone." They claim an estimated loss to these three institutions from sequestration will be $20 million in funding from the NSF in 2013.
Simply put, with the new cuts, it is really difficult to see how the U.S. scientific program can flourish. With funding levels so low a lot of excellent science cannot be funded. Promising new lines of research are not started, and long term projects don't get the funds to be renewed.
But it is not just the scientific product that is in jeopardy. Federal funding also funds the salaries for trainees who become the future scientific workforce. After years of training, at great personal sacrifice, they are now facing this dismal scenario. A decrease in morale is rapidly percolating throughout the system, tainting the optimism of the next generation.
To be sure, times are tough for everyone. Why pity scientists when unemployment rates are high across all sectors?
First, science is an important social endeavor where we learn about ourselves and the universe around us. It teaches us creativity with intellectual rigor and logic that enhance our lives at multiple levels.
These are not trivial benefits; this training might originate in universities but slowly seeps through the fabric of our culture to make for a more enlightened citizenry. But even speaking from a purely economic perspective, there are excellent fiscal reasons why science should perhaps be the last sector to face cuts.
The science dollars that are being discussed are a pittance: less than 1 per cent of the federal budget. It is ludicrous to entertain the idea of attacking the national debt by cutting down on this sliver of the economic pie.
Besides, scientists are the true innovators, with science being the real engine of growth in this competitive global economy. Science provides the know-how and expertise that are relayed as baton to entrepreneurs and the corporate sector.
More visibly, the NIH provides grants to small businesses to exploit nascent areas of science for commercialization. Science provides the technology to deal with national disasters, epidemics and bioterrorism. And then there is, of course, health -- the NIH's stated reason d'être.
Research is the only way we can improve upon diagnosis and treatments that will allow people to long, healthy, and productive lives. Solutions here can ultimately bring down health care costs -- the far bigger driver of our national indebtedness. It is the NIH that funds research on diseases such as diabetes, neurological diseases such as Alzheimer's and Parkinson's disease, cancer, heart disease, infectious diseases, liver, kidney, immune-mediated diseases, you name it. And these are just the more common ailments. There are so many others less well known, often devastating, frequently genetic, that as a group cause enormous havoc to human health.
The only hope for patients and their caregivers is through research.
We should have never have placed our scientific enterprise hostage to such economic brinkmanship. Funding of science really is discretionary in name only; it is absolutely essential for the very survival of our country.
So what must be done? We can petition legislators to stop sequestration. But that is not enough. We should ask that science budgets grow consistently to keep up with economic growth and inflation. Only with long-term support of our scientific enterprise can we keep the U.S. competitive in a global economy, its citizens prosperous and healthy.
Only then can we recruit and maintain the next generation of our work force, a motivated crew that just needs the resources. The trajectory of science funding must be upwards, not downwards, and definitely not off a cliff.