EDITORIAL
The Great Depression of Biomedical Science
M
any people date the onset of the Great Depression to Black Tuesday, the great stock market crash of October 29, 1929. But, in fact, the onset of the Great Depression was much slower, as the economy worsened throughout the term of Herbert Hoover, and remained at a low ebb through the first two terms of Franklin Roosevelt. It did not begin to recover until about 1942, when the United States entered World War II, and there was a subsequent increase in demand for manufactured goods, particularly war materiel. That accounting would mark the Great Depression as having spanned a slide in the economy lasting about six years, with a plateau at a low level lasting about the same amount of time. Now, compare that with the fate of the NIH at the hands of the US Congress and two consecutive Presidents, in the years since 2003 (Fig. 1). That was the year when Congress finished “doubling” the NIH budget, a well-intentioned plan that began under Bill Clinton and finished under George Bush. Since that peak, with the exception of the American Recovery and Reinvestment Act (ARRA Stimulus) funds, which were spent in an idiosyncratic way that exacerbated rather than helped the problem (more about that later), there has been an almost continual fall in the NIH budget, so that it has lost about $5B or 15% in spending power from its peak to the current year FY14 budget. By this measurement, biomedical science in the US is now in its second decade of declining annual spending on biomedical research, a period of continual decline that has lasted almost twice as long as the economic decline during the Great Depression. To this we have to add the reductions in spending by pharmaceutical companies, at least in the CNS drug arena, as large and expensive clinical trials in neuroprotection for stroke and Alzheimer’s disease have failed, and one pharmaceutical manufacturer after another has diminished its support for CNS research. The net effect is that the Great Depression in Biomedical Science support has now lasted almost as long as the Depression of the 1930’s. And there is no end in sight, as neither the Right nor the Left has generated champions for biomedical research. Of course, support for biomedical research cannot be equated entirely with dollars spent. There is a right way to spend money on biomedical research, as can be seen in the graph in Figure 1, from 1985–1998. During
that era, there was a slow, gradual increase in the NIH budget from about $11B to about $18B (in 2014 dollars) over 14 years. This gradual increase, at a rate of about 3% per year, was achieved with bipartisan support. With it, biomedical science blossomed, as the investment made each year in training, infrastructure, and building research teams, could pay off with sustained support that built upon those resources in succeeding years. From 1998 to 2003, the “doubling” of the NIH (actually an 84% increase in real dollars) was welcome, but it caused many institutions to build additional infrastructure for the anticipated increase in the number of working scientists. When the doubling stopped in 2003, the NIH stagnated for two more years, and then began a slow, inexorable decrease in funding that has reached its nadir in FY13 and FY14, which are averaging 15% below the peak year. While that may not seem like a big loss, for institutions that built new buildings counting on increased indirect cost recovery, this shortfall has caused major damage. For example, a major research university with $100M in NIH-sponsored research at the end of the doubling, would now be down to about $85M. If it had an indirect cost rate of 50%, that would mean that the university would find itself with an annual $7.5M shortfall in funds to pay for their research. Given that its buildings remain as a fixed cost, the result is less money available to hire new faculty or invest in existing programs. Thus, just as investigators need support the most, their institutions are most hard-pressed to find the money to provide it. From the point of view of the investigators who used to derive their funding from the 15% of the NIH budget that no longer exists, things are much worse. The “lucky ones” who work at teaching institutions are finding themselves with larger class loads, while their hard won investigative skills and programs whither on the vine. Those who were in soft-money positions are finding themselves unemployed. The ARRA Stimulus, which increased NIH support in 2009–2011, was of little help. It looked for “shovel ready” projects, which largely translated into short term grants that pumped up expectations, and then left almost all the recipients feeling caught short, as there was no funding that could allow them to continue their work. In the end, much of the advantage of the “doubling” and the ARRA Stimulus
C 2014 American Neurological Association V 169
ANNALS
of Neurology
FIGURE 1: The annual budget of the National Institutes of Health, from 1985–2014, calculated in 2014 dollars (not including ARRA funds).
have been squandered by failure to follow through and support the scientific programs that were being built. What do we need, and what can we do about it? We need a commitment from the US Congress to provide a steady level of funding for the NIH that at least keeps pace with inflation. We would not mind having a 1–3% real growth rate, as the country enjoyed from 1985–1998. But it is critical to avoid the wastage
170
of public dollars that occurs with repeated expansions and contractions. These help no one. How can we get our Congress to realize this? Fortunately, members of the American Neurological Association live in all 50 states, and in many of the congressional districts of the key Congressmen on the appropriations committees that govern the NIH budget. If every ANA member (and others who read these words) simply made an appointment with their Representative or Senator at their home office, we could make our case to them. In fact, groups of ANA members, and other concerned physicians and scientists, may make a deeper impression than individual visits. Why meet in the home district office, not Washington, DC? In the home district, the representatives often have time to meet with concerned constituents personally. Regardless of your political leanings or those of your Representative, the message should be the same: The NIH needs strong and steady support. It is a generator of innovation and jobs in the economy; it contributes to the health and well-being of Americans; and strong and steady support is simply the right way to do it, if we want to gather the fruits of our investment. Clifford B. Saper, MD, PhD Editor-in-Chief
DOI: 10.1002/ana.24120
Volume 75, No. 2
The Great Depression of Biomedical Science
M
any people date the onset of the Great Depression to Black Tuesday, the great stock market crash of October 29, 1929. But, in fact, the onset of the Great Depression was much slower, as the economy worsened throughout the term of Herbert Hoover, and remained at a low ebb through the first two terms of Franklin Roosevelt. It did not begin to recover until about 1942, when the United States entered World War II, and there was a subsequent increase in demand for manufactured goods, particularly war materiel. That accounting would mark the Great Depression as having spanned a slide in the economy lasting about six years, with a plateau at a low level lasting about the same amount of time. Now, compare that with the fate of the NIH at the hands of the US Congress and two consecutive Presidents, in the years since 2003 (Fig. 1). That was the year when Congress finished “doubling” the NIH budget, a well-intentioned plan that began under Bill Clinton and finished under George Bush. Since that peak, with the exception of the American Recovery and Reinvestment Act (ARRA Stimulus) funds, which were spent in an idiosyncratic way that exacerbated rather than helped the problem (more about that later), there has been an almost continual fall in the NIH budget, so that it has lost about $5B or 15% in spending power from its peak to the current year FY14 budget. By this measurement, biomedical science in the US is now in its second decade of declining annual spending on biomedical research, a period of continual decline that has lasted almost twice as long as the economic decline during the Great Depression. To this we have to add the reductions in spending by pharmaceutical companies, at least in the CNS drug arena, as large and expensive clinical trials in neuroprotection for stroke and Alzheimer’s disease have failed, and one pharmaceutical manufacturer after another has diminished its support for CNS research. The net effect is that the Great Depression in Biomedical Science support has now lasted almost as long as the Depression of the 1930’s. And there is no end in sight, as neither the Right nor the Left has generated champions for biomedical research. Of course, support for biomedical research cannot be equated entirely with dollars spent. There is a right way to spend money on biomedical research, as can be seen in the graph in Figure 1, from 1985–1998. During
that era, there was a slow, gradual increase in the NIH budget from about $11B to about $18B (in 2014 dollars) over 14 years. This gradual increase, at a rate of about 3% per year, was achieved with bipartisan support. With it, biomedical science blossomed, as the investment made each year in training, infrastructure, and building research teams, could pay off with sustained support that built upon those resources in succeeding years. From 1998 to 2003, the “doubling” of the NIH (actually an 84% increase in real dollars) was welcome, but it caused many institutions to build additional infrastructure for the anticipated increase in the number of working scientists. When the doubling stopped in 2003, the NIH stagnated for two more years, and then began a slow, inexorable decrease in funding that has reached its nadir in FY13 and FY14, which are averaging 15% below the peak year. While that may not seem like a big loss, for institutions that built new buildings counting on increased indirect cost recovery, this shortfall has caused major damage. For example, a major research university with $100M in NIH-sponsored research at the end of the doubling, would now be down to about $85M. If it had an indirect cost rate of 50%, that would mean that the university would find itself with an annual $7.5M shortfall in funds to pay for their research. Given that its buildings remain as a fixed cost, the result is less money available to hire new faculty or invest in existing programs. Thus, just as investigators need support the most, their institutions are most hard-pressed to find the money to provide it. From the point of view of the investigators who used to derive their funding from the 15% of the NIH budget that no longer exists, things are much worse. The “lucky ones” who work at teaching institutions are finding themselves with larger class loads, while their hard won investigative skills and programs whither on the vine. Those who were in soft-money positions are finding themselves unemployed. The ARRA Stimulus, which increased NIH support in 2009–2011, was of little help. It looked for “shovel ready” projects, which largely translated into short term grants that pumped up expectations, and then left almost all the recipients feeling caught short, as there was no funding that could allow them to continue their work. In the end, much of the advantage of the “doubling” and the ARRA Stimulus
C 2014 American Neurological Association V 169
ANNALS
of Neurology
FIGURE 1: The annual budget of the National Institutes of Health, from 1985–2014, calculated in 2014 dollars (not including ARRA funds).
have been squandered by failure to follow through and support the scientific programs that were being built. What do we need, and what can we do about it? We need a commitment from the US Congress to provide a steady level of funding for the NIH that at least keeps pace with inflation. We would not mind having a 1–3% real growth rate, as the country enjoyed from 1985–1998. But it is critical to avoid the wastage
170
of public dollars that occurs with repeated expansions and contractions. These help no one. How can we get our Congress to realize this? Fortunately, members of the American Neurological Association live in all 50 states, and in many of the congressional districts of the key Congressmen on the appropriations committees that govern the NIH budget. If every ANA member (and others who read these words) simply made an appointment with their Representative or Senator at their home office, we could make our case to them. In fact, groups of ANA members, and other concerned physicians and scientists, may make a deeper impression than individual visits. Why meet in the home district office, not Washington, DC? In the home district, the representatives often have time to meet with concerned constituents personally. Regardless of your political leanings or those of your Representative, the message should be the same: The NIH needs strong and steady support. It is a generator of innovation and jobs in the economy; it contributes to the health and well-being of Americans; and strong and steady support is simply the right way to do it, if we want to gather the fruits of our investment. Clifford B. Saper, MD, PhD Editor-in-Chief
DOI: 10.1002/ana.24120
Volume 75, No. 2
