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Thoughts Prior to Sequestration

By Paul B. Rothman, M.D.
February 27, 2013

For more than a hundred years, America’s research universities and academic medical centers have led the world in research, teaching and patient care. But the impending budget sequestration threatens our ability to pursue all three — particularly our efforts in research and improving our patients’ health. 

No one disputes that we face a challenging fiscal situation, and that we must address it. But we are on auto-pilot toward $1.2 trillion in nonprioritized, thoughtless budget cuts over the next 10 years: half of them affecting national defense agencies and the other half affecting domestic agencies, including vital research centers such as the National Institutes of Health. Sequestration will also cut Medicare payments to physicians and other health care providers by $11 billion annually. Friday’s deadline looms large.

Federal funding of university-based research plays an essential role in our national economy. It is one of the best examples of how government should work, filling a need that the private sector alone cannot and will not ever fill. According to a recent report from United for Medical Research, in 2012, NIH funding alone supported nearly 402,000 jobs and produced $57.8 billion in economic activity nationwide. If the projected cuts to the National Institutes of Health budget become real, 20,500 jobs will be lost along with $3 billion in economic output this year.  The impact would be particularly great in cities like Baltimore, whose economies depend largely on health care, higher education, research and biotechnology. At Johns Hopkins, we conducted $2.3 billion in federally funded research in 2012. Along with our health system, the university contributes $10 billion annually in economic activity to the region. 

More important in the long run, federal funding drives American research and development that for many years has been the best in the world.

Such dominance is fragile. Remember the lost supremacy of other U.S. industries: steel, shipping and automobiles, for instance. The forces of globalization eventually permitted other nations to produce products at lower prices and beat us at our own game. Many of these nations, particularly China and India, are now turning their attention to education and science and ramping up investments in biomedical research and development. They increasingly see this investment as a way to secure their future success. Without immediate action to avert sequestration and to commit to reinvestment in research and development, we are at risk of losing our position as the world leader in biomedical research.  

Consider this: If trends continue unchanged, in the next five years, China’s financial commitment to biomedical research will be twice that of the United States.  

Of course, it’s not just about the economy. Federal investment in research is not only a catalyst for growth, it also saves lives. Nationally, between 1990 and 2009, we’ve cut the cancer death rate by 16 percent in women and 24 percent in men. From 1968 to 2008, death from cardiovascular disease has been reduced by more than 60 percent. Polio and smallpox are unheard of in this country, and HIV/AIDS is a chronic disease, rather than a death sentence.    

Past federal investments in research have yielded game-changing results. For example, in 1978, two Johns Hopkins researchers, Dan Nathans and Hamilton Smith, received the Nobel Prize for discovering restriction enzymes and using them to splice genes. 

This advance in basic knowledge led to a remarkable new technology that allowed scientists for the first time to work with the building blocks of life and sparked the biotechnology revolution. Supported by taxpayer funding, we created whole new industries for America while developing knowledge that saves lives and improves health around the world.

As March 1 approaches, remember that we have the best research and development apparatus the world has ever known. Our discoveries and innovations now allow us to sequence all of an individual’s genes in a day, to provide extraordinary images of the brain, heart and other organs to gain insights into function and disease, and to perform computational analyses about populations that can be used for making decisions about the care of individual patients. Our researchers are poised to exploit these developments to find the next great advances.

And so we call upon our national leaders to prevent the pernicious cuts of sequestration from taking place. For the health of our communities and the nation, we instead ask them to address the difficult tasks of entitlement and tax reform, and prioritized, careful reductions in federal spending.

Paul B. Rothman, M.D.
Dean of the Medical Faculty
CEO, Johns Hopkins Medicine