Marching on Washington

By Dean/CEO Edward D. Miller, M.D.

Academic medical centers have gone to work in our nation’s capital this spring—and Johns Hopkins has joined their crusade. We are marching on Washington to educate members of Congress on our big common concern: government funding for biomedical research. After years of hefty increases, the National Institutes of Health, this nation’s primary research engine, faces the prospect of an overall funding freeze and a $233 million cut in research grants.

I fear such a move. A cut in research funding, if approved by Congress, could have long-lasting consequences for America’s competitiveness in moving medicine forward. The astonishing advances we’ve witnessed in recent years in understanding complex diseases could, in fact, be slowed dramatically. What’s more, denied federal grants, many of our bright young investigators might well opt to follow other career opportunities.

Because Hopkins leads all universities in NIH financial support, our research labs will feel the impact of this cut in support more than others. Our level of government funding is, of course, a grand compliment to the string of medical discovery success stories that have sprung from this institution. But it’s also because we’ve come to count on this funding that we’re taking such an active role in convincing Congress to expand federal backing for medical science.

President Bush’s budgetary restraint on research—for the fourth year in a row—is no doubt the result of shifting priorities in Washington. But let’s take a look at what resulted when the opposite held  true—when research was the priority. In 1998, President Clinton and the Republican Congress agreed to double the NIH research budget over a five-year span, and with that huge bipartisan investment came such amazing discoveries as biomarkers for cancers. Very quickly, that five-year investment started to pay off. With the ability to test for these new biomarkers, physicians began diagnosing cancer earlier, and researchers discovered more effective therapies. And with those advances cancer deaths in the United States began to drop for the first time since the nation started keeping such statistics 75 years ago.

I am convinced that we are on the verge of a dramatic transformation of health science discovery. I believe that this is the worst possible moment to change course in supporting this kind of research. If Congress wants to ensure that its earlier commitment brings home the biggest bang for the buck, it needs to support more, not less, funding for laboratory investigations.

Here’s why I think larger appropriations are critical to our nation’s future:

• We don’t want to lose one of our last strategic advantages—leadership in scientific research and health care. The United States undoubtedly has lost ground in areas like automobile and other kinds of manufacturing, but we remain the clear leader in biomedicine. That won’t last without reinvigorated federal commitment.
• Investing in improved human health has to remain a national economic imperative. The best way to curb dangerously ballooning Medicare and Medicaid costs is by federal support of research. As that funding reaps more effective treatments, earlier interventions and even cures, medical insurance expenses go down. (Lost productivity and other negative effects of disease, according to NIH, cost the nation’s economy $136 billion a year.)
• We can’t afford to lose a generation of enthusiastic, inquisitive and creative young researchers who, without a doubt, will become discouraged as NIH grants become scarce and out of reach for most of them.

One final word: It’s ironic that while biomedical research is targeted for budget cuts, the president has earmarked mathematics and the physical sciences for a large boost to help improve America’s competitiveness. Yet the two branches of science cannot be separated. If the United States wants to remain the world leader in the sciences, all forms of investigation must be amply supported. To borrow a phrase from another White House program, no science should be left behind.

Interestingly, historic dividing lines between the sciences are now disappearing. Computational science has become an integral part of biomedical research. Interdisciplinary teams are mining  data, hunting genes, modeling molecular networks, identifying biomarkers of disease at early stages and finding new treatments. The physical and biological sciences go hand in hand. Both merit increased federal backing.

It’s an exciting time in medicine. That’s what we must convey to our friends in Congress. Early in this decade, academic medical centers got complacent. Thanks to the continuing flow of huge sums of federal dollars to our research labs, we felt we didn’t have to raise our voices in the hallways of power. We were wrong. We learned that it’s our job to deliver the message that biomedical investigators are on the brink of tremendous scientific advances that will make life better for millions of Americans. But this can happen only if there are sufficient funds to stimulate basic and translational research.