Trump 2020 Budget cuts billions of dollars from National Institutes of Health

The Trump administration's 2020 budget proposal has been released and one thing is obvious: the administration does not think the National Institutes of Health's spending is a very good deal.

The budget suggests cutting $ 4.5 billion, about 11% of the agency's budget for 2019. We should say that estimates of the total cut reported by different media range from $ 4.5 billion to $ 6 billion. Some of the figures in the budget document may be wrong. "The most defensible figure … could be – $ 4.9 billion," says Matthew Hourihan, director of R & D budget analysis at the American Association for the Advancement of Science, in an email. But he's still figuring it out. In any case, it's a lot of money.

Congress will have to approve the budget, and this is not obvious. Recall that in 2017, President Trump asked Congress, under Republican control, to cut $ 7 billion from NIH spending over two years. Instead, Congress has chosen to increase the agency's budget by $ 2 billion. Now that Democrats control the House of Representatives, a $ 4.5 billion cut seems even less likely.

The president's budget request has no law but gives the public an idea of ​​the White House's priorities. This year, they do not fund scientific research. The budget also includes a $ 1 billion reduction from the National Science Foundation, Science reports.

In the past, the White House has justified cuts in the NIH involving unnecessary spending. "It's only in Washington that you literally judge the success of something according to the amount of money you invest in the problem, not whether the problem is solved or whether nothing has been done, "said then-press secretary Sean Spicer in 2017

But we can judge the success of the NIH by measures other than the amount spent. For decades, scientists have been studying a version of this specific question: "What are we really buying from public spending on biomedical research?"

Many, finally. So, let's go over some of the evidence.

Here is what money spent at NIH we "buy". Spoiler: That's good.

NICHD / N. Gupta / Flickr

NIH is not limited to a research campus in Bethesda, Maryland. His the the main funder of biomedical research in the country's universities. About 80% of the NIH budget is spent on these grants.

It turns out that giving money to some of the smartest people in the country to solve difficult problems in medicine and biology generates good products and ideas, and stimulates the economy.

1) New patents for drugs, medical devices and other technologies

In 2017, Science published a study on the impact of NIH grants over a 27-year period.

Key Finding: 8.4% of all NIH grants generate patents – for new drugs, medical devices, or other drug-related technologies.

The authors of Science The paper had previously explained that a "$ 10 million increase in NIH funding resulted in a net increase of 2.3 patents." They estimate, roughly, that each patent is worth about $ 11.2 million in 2010. "A calculation on the back of the envelope indicates[s] that a $ 10 million increase in NIH funding would generate a market value of $ 34.7 million, "they said in an NBER article. Not a bad bet.

A single invention can be a significant advance in biotechnology. The most cited NIH patent since 2000 was a tiny and extremely important invention: microscopic valves that allow scientists to create fluid "circuits" that work much like computer chips. According to Battelle, a private research firm, the NIH would have spent about $ 500,000 to develop these valves. Since then, biotechnology companies have seized upon the invention to create even smaller versions of chemistry labs that can diagnose diseases such as HIV and Ebola (these devices are sometimes referred to as "lab-on-a-chip" devices). . It's an invention that has stimulated a whole new biotechnology industry that saves lives.

2) These patents then inspire new patents

the Science Paper's secondary conclusion may be just as important: grant money also has a carry-over effect on the private sector. About 30% of all scientific articles generated by NIH grants are city by patent applications from private companies.

This means that even if a grant does not directly generate a patent, it has a good chance of helping the thinking behind the discovery of another.

In addition, some research suggests that government funding is more effective in reviving this virtuous circle than private sector funding: NIH-funded patents are cited in future patents at twice the rate of private sector patents , a year 2014. Nature Biotechnology paper found.

In addition, the Science The analysis shows that future patents cite both "basic" and "applied" research. ("Basic" research seeks to understand the workings of biological processes and answers such questions as: how does the retina work? "Applied" research seeks to generate ideas or products that can be used: this medical device can it improve the retina? working?)

Parity between basic and applied research means that generating knowledge is just as valuable as designing direct solutions to problems.

Between 2003 and 2013, each patent generated by an NIH grant was cited on average by five future patents, according to Battelle.

Again, this means that the dollars spent by the NIH for research are prompting other research institutes and industries to spend money on research and development, generating ideas for change and saving lives.

Overall, Battelle calculated that every $ 100 million spent on NIH research results in a significant loss of productivity. Additional $ 105.9 million in future research and development in the public and private sectors.

3) These patents form the basis for new biotechnology companies

NIH money arrives at research institutes across the country. In 2014, a report in the journal Research Policy asked: what happens to local economies that see the influx of NIH funds?

Quite simply, where NIH funds flow, new biotech companies are following. "A $ 1-million increase in the average amount of federal R & D funding is associated with a 5 to 58 per cent increase in the number of local biotechnology firms created a few years later," they said. reported the authors.

In 2013, the Science Coalition, a non-profit organization for science advocacy, released a report on 100 companies created through federal research funds. Most of them are rather small and employ a few people, even a few dozens. They produce elements such as custom DNA strands for use in genetic engineering or compounds that make pharmaceuticals more water soluble.

NIH-funded research has also generated huge new industries. Consider the Human Genome Project, to which genetic testing companies such as 23andMe and the entire genomics industry owe their existence. The human genome project cost about $ 3.8 billion. It is estimated that it generated $ 796 billion in economic impact.

4) All this research gives us life-saving medicines

In 2011, the New England Journal of Medicine published a report that public sector funding was more effective at generating important new drugs than private sector spending.

In reviewing decades of drug approvals by the Food and Drug Administration, researchers have found that "virtually all the important and innovative vaccines introduced over the last 25 years have been created by PSRIs. [public sector research institutions]. "

Their definition of PSRI includes "all universities, research hospitals, non-profit research institutes and federal laboratories in the United States", which is not just an expense for NIH.

The FDA prioritizes drugs in the approval pipeline based on the potential impact. Drugs developed at public research institutes were more than twice as likely as substances developed in the private sector. The analysis revealed that "46.2% of requests for new drugs from PSRI were reviewed as a priority, compared to 20.0% of requests based solely on private sector research, a factor multiplied by 2, 3 ".

And the public sector is particularly good at creating drugs to cure deadly diseases. According to the report, of the 153 drug approvals that began in public research institutes, 40 concerned cancer treatment and 36 concerned infectious diseases.

More specifically, research has also revealed that NIH expenditures favor the discovery of new drugs. A study conducted in 2012 found that a 10% increase in funding for a particular disease "results in an increase of about 4.5% in the number of new drugs entering clinical trials on the subject." Man (Phase I trials), after a delay of up to 12 years.

Here's a famous example: In the '50s and' 60s, the work of NIH researcher Julius Axelrod showed how the neurotransmitter works in the brain, which led to a Nobel Prize. But more importantly, his ideas have led to the drugs we now use to treat depression. «All major SSRIs [selective serotonin reuptake inhibitors] pharmaceutical companies thanks to the fundamental discoveries of Axelrod ", NEJM reports.

Could the NIH benefit from cost reduction? May be.

Paul R. Odgren, PhD, University of Massachusetts / Flickr School of Medicine

In the past, the White House has argued that NIH spending has gone out of control.

"About 30% of the grant spent is used for indirect expenses, which, as you know, means that this money is used for something other than ongoing research," the health secretary told reporters. and Social Services, Tom Price. in 2017, justifying the proposed 18% reduction in NIH funding for the 2018 budget.

It is true that NIH funding also covers overhead costs such as electricity bills and laboratory equipment. And yes, it is legitimate to fear that these costs will skyrocket. Stat News has the best explanation of this argument here. Journalist Meghana Keshavan explains:

Critics suggest that the system encourages universities to increase their overhead costs because refund rates are negotiated based on the previous year's expenses. So, if a school builds a new fantasy lab a year, it may claim the need for a higher repayment rate the following year.

Should universities like Harvard, which have billions of dollars in funding, get federally-funded funding to continue to operate?

The Government Accountability Office – which analyzes the government's policies on inefficiency – reported in a 2016 report the potential for additional costs of indirect costs to the NIH, urging the institute to put in place programs for better investigate fraud and abuse.

There is therefore a legitimate debate about NIH funding. But it is also clear that the dark and brutal cuts proposed by the Trump administration will have the immediate effect of stifling scientific progress.

On the one hand, science needs stable funding. Projects are funded over several years. Yet, Congress can change the NIH budget every year if it wishes. Instability makes it more difficult to finance multi-year projects.

Clippings at NIH likely to face opposition

And already, the competition for NIH grants is intense. Funding has almost plateaued over the past decade, while the cost of research has been steadily increasing and an ever-growing pool of doctorates is competing for a relatively small amount of funding.

Consider this: In 2000, more than 30% of NIH grant applications were approved. Today, it's close to 17%. This is not an idiotic calculation: the less money there is, the less money you pay for projects. If Trump cuts are adopted, it will probably mean hundreds of fewer grants.

Congress will ultimately decide whether or not to adopt Trump's budget.

Again, it is likely that these cuts will not pass.

But if Congress votes to cut funding for the NIH – which could very well happen – who knows what ideas and what breakthroughs we will miss?

(Many thanks to Matthew Hourihan, director of research budget analysis and development at the American Association for the Advancement of Science, who helped compile this research.)