November 19, 2012

The Looming Threat to Medical Research Funding

As negotiations begin to avoid the year-end fiscal cliff, powerful lobbies are girding for battle. Defense spending will surely become a combat zone. In another arena, labor unions and the AARP are marshaling forces to prevent reductions in Social Security and Medicare benefits. No question: these issues will be major battlegrounds in the weeks ahead.

But I fear that other areas of discretionary spending will end up taking big hits, because it's easier for policymakers to trim where the public won't see much immediate impact. I worry that cuts will occur in an area I care most about these days: medical and health research.

As an 83-year-old man with Parkinson's Disease, prostate cancer, and a big fear of dementia, my concern about these funds admittedly is based on self-interest. But major research breakthroughs in recent years suggest we may be on the verge of finding cures or at least major advances in treatment for costly diseases like Alzheimer's, Parkinson's, and cancer. Given the potential savings in dollars and lives, funding this research brings a positive cost/benefit ratio... certainly much higher than the cost/benefit ratio for the Iraq and Afghanistan wars.

Non-Defense Discretionary Spending Is at High Risk
This point was made in an op-ed piece in the Washington Post last week by David Kamin, professor at New York University School of Law and self-described budget geek. As special assistant to the president, he sat in on last year's federal budget talks.

Those negotiations put caps on discretionary spending and effectively reduced funding for all government agencies by more than ten percent over the next ten years. In spite of those cuts, Kamin predicts that discretionary spending -- especially outside the Pentagon-- will attract the budget cutters' attention now. He explains:
If  policymakers want savings from entitlement programs such as Medicare or Social Security, or if they want additional revenue, they must, in relatively short order, come up with the specific ways to reduce those entitlements or raise that revenue. The lines on the spreadsheet must be filled with painful decisions about premiums and co-pays, benefit levels, and tax rates.
In contrast, cutting discretionary spending over the next five or ten years "looks like a piggy bank to the negotiators." Since specific decisions on discretionary spending are made in annual budgets, the pain is deferred. The negotiators get to claim big savings while leaving it to future policymakers to actually ax the programs.

Non-defense discretionary spending is at greatest risk. Again, Kamin:
The Pentagon has many defenders on both sides of the aisle and a small army of lobbyists deployed by defense contractors. The same cannot be said for, say, the Consumer Product Safety Commission.
Even with just the current caps, non-defense discretionary spending is set to fall to its lowest level as a share of the economy in 50 years, Kamin says. He concludes:
The problem is that cutting discretionary spending can look easy to negotiators, especially relative to the alternatives. But, while number crunchers can generate savings with a few clicks, no one should forget that  there will be deep consequences for America's future -- and the real programs with real effects for this country are on the line.
Downward Trend in Biomedical and Health Research
Last month, in its annual report on biomedical and health research and development (R&D) spending, Research America reported that spending from all sources declined by more than $4 billion -- 3 percent -- between Fiscal Year 2010 and 2011, the first drop in overall spending since RA began compiling the data in 2002.

This slide followed an uptick in funding in the previous two years thanks to President Obama's economic stimulus package, which allocated an additional $10.4 billion to the National Institutes of Health. But the $39.5 billion in federal funding for FY2011 dropped 14% from the year before.

According to the RA report, the research investment landscape in the U.S. could worsen over the next decade, while it expands in other countries. Currently more that 80 percent of R&D among Big Pharma companies occurs in the U S. but that could change. "As R&D spending abroad outpaces federal investment here at home, U.S. companies will set up shop in countries with stronger policies to support research," said Mary Woolley, RA's president.

I've been particularly excited by the many reports I'm seeing of new initiatives coming out of our investment in the Human Genome Project. Therapies based on a person's genetic profile are already underway and show the potential for "personalized medicine" which could transform routine clinical practice in the next few years, unless we neglect to fund continuing research in this area.

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