07/09/2018
Aaron CarrollThe peer review process for awarding NIH grants has some problems. Less money is being awarded, and the buying power of the NIH has declined. It’s not clear that grants are being awarded as fairly as possible, either.
This episode was adapted from a column I wrote for the Upshot. Links to references can be found there.
06/20/2018 Aaron CarrollThe following originally appeared on The Upshot (copyright 2018, The New York Times Company).
The medical research grant system in the United States, run through the National Institutes of Health, is intended to fund work that spurs innovation and fosters research careers. In many ways, it may be failing.
It has been getting harder for researchers to obtain grant support. A study published in 2015 in JAMA showed that from 2004 to 2012, research funding in the United States increased only 0.8 percent year to year. It hasn’t kept up with the rate of inflation; officials say the N.I.H. has lost about 23 percent of its purchasing power in a recent 12-year span.
Because the money available for research doesn’t go as far as it used to, it now takes longer for scientists to get funding. The average researcher with an M.D. is 45 years old (for a Ph.D. it’s 42 years old) before she or he obtains that first R01 (think “big” grant).
Given that R01-level funding is necessary to obtain promotion and tenure (not to mention its role in the science itself), this means that more promising researchers are washing out than ever before. Only about 20percent of postdoctoral candidates who aim to earn a tenured position in a university achieve that goal.
This new reality can be justified only if those who are weeded out really aren’t as good as those who remain. Are we sure that those who make it are better than those who don’t?
A recent study suggests the grant-making system may be unreliable in distinguishing between grants that are funded versus those that get nothing — its very purpose.
When a health researcher (like me) believes he has a good idea for a research study, he most often submits a proposal to the N.I.H. It’s not easy to do so. Grants are hard to write, take a lot of time, and require a lot of experience to obtain.
After they are submitted, applications are sorted by topic areas and then sent to a group of experts called a study section. If any experts have a conflict of interest, they recuse themselves. Applications are usually first reviewed by three members of the study section and then scored on a number of domains from 1 (best) to 9 (worst).
The scores are averaged. Although the bottom half of applications will receive written comments and scores from reviewers, the applications are not discussed in the study section meetings. The top half are presented in the meeting by the reviewers, then the entire study section votes using the same nine-point scale. The grants are then ranked by scores, and the best are funded based on how much money is available. Grants have to have a percentile better than the “payline,” which is, today, usually between 10 and 15 percent.
Given that there are far more applications than can be funded, and that only the best ones are even discussed, we hope that the study sections can agree on the grades they receive, especially at the top end of the spectrum.
In this study of the system, researchers obtained 25 funded proposals from the National Cancer Institute. Sixteen of them were considered “excellent,” as they were funded the first time they were submitted. The other nine were funded on resubmission — grant applications can be submitted twice — and so can still be considered “very good.”
They then set up mock study sections. They recruited researchers to serve on them just as they do on actual study sections. They assigned those researchers to grant applications, which were reviewed as they would be for the N.I.H. They brought those researchers together in groups of eight to 10 and had them discuss and then score the proposals as they would were this for actual funding.
The intraclass correlation — a statistic that refers to how much groups agree — was 0 for the scores assigned. This meant that there was no agreement at all on the quality of any application. Because they were concerned about the reliability of this result, the researchers also computed a Krippendorff’s alpha, another statistic of agreement. A score above 0.7 (range 0 to 1) is considered “acceptable.” None were; the values were all very close to zero. A final statistic measured overall similarity scores and found that scores for the same application were no more similar than scores for different applications.
There wasn’t even any difference between the scores for those funded immediately and those requiring resubmission.
It would be easy to mistake this study as a death knell for the peer review process. It’s not. A careful reader must note that all of the grants in this study were exceptional. They succeeded, after all. Since the N.C.I. funds only about 10 percent of grants, we’re looking only at proposals in the best decile, and it’s likely that there might be less variability in scores among those than among grants occupying the full spectrum of quality.
This should still concern us greatly. This system was devised back when more than half of submitted grants were funded. That’s very different than what we see today.
The current system favors low-risk research. If you’re going to fund only a small percentage of proposals, you tend to favor the ones most likely to show positive results. You don’t want to have to defend null findings as a “waste of money.”
The current system favors experienced researchers over new ones. They have thicker curriculum vitae, more preliminary data and name recognition. Moreover, they know how to work the system. At this point in my career, I know how to write multiple grants efficiently. I’m better at it than I used to be.
The current system can also be biased against women and minorities in ways that could keep them out of funding range. The system is not blinded, and many studies have shown that even after controlling for other factors, the ways in which grants are discussed, scored and funded can favor men over women, and whites over minorities.
If researchers are getting into the top 10 percent more than others based on such factors, especially with less and less money available, many great proposals — and many great researchers — are being sidelined inappropriately.
We may be missing out on a lot of excellent, and perhaps novel, work that can’t break into the top 10 percent because of structural problems. There are things we could do to fix that. One might be, of course, to increase funding across the board. John Ioannidis has proposed that we fund researchers, not research. A group of informaticists from Indiana University has suggested a percentage of funding be put to all scientists for a vote.
Other solutions are more radical. One might involve a modified lottery. The current system seems to do reasonably well at discriminating between “bad” and “good” grants. Once those good ones are put aside, we might do better by assigning funding through chance. Ferric Fang and Arturo Casadevall, who are researchers and journal editors, have proposed that such a system could reduce bias and increase diversity among researchers, suggesting that seniority and other factors still play too large a part in funding decisions.
They make the case that we already have a de facto lottery now, except it’s not random, and therefore unfair.
The current granting system doesn’t just fund the researchers of today — it also steers the careers of tomorrow. Should it fail, the repercussions will be felt for decades.
06/16/2017 Bill GardnerI recently argued that:
The drug overdose epidemic is a public health catastrophe in the same class as AIDS.
Arguably, it’s worse. Annual deaths by drug overdose are substantially higher than the worst year of the AIDS epidemic. The current very rapid increase in deaths by drug overdose shows no signs of slowing. Drug overdose is now the leading cause of death for Americans under 50. AIDS never achieved that.
If you measure the magnitude of an epidemic by the sum of the years of life lost by the victims, drug overdoses compete with cancer, not just AIDS. Many more Americans die of cancer (about 600,000) than drug overdose (an expected 60,000 in 2017). But more than half of cancer deaths occur in people 75 years or older (UK data). The average drug overdose victim dies in his or her early 40s and loses many more years of life.
Are we responding to the drug overdose epidemic in a way that is commensurate to these facts?
I don’t think the NIH is. The 2017 NIH Budget request slides presented by Director Francis Collins discussed:
These are all great things to do with federal dollars. But it’s remarkable that Collins did not mention drug or alcohol abuse or the current epidemic.
Why aren’t we focused on this epidemic? It’s the same problem that plagued the early years of AIDS. The victims were stigmatized and those not in their families or neighbourhoods didn’t take their deaths seriously.
Turning the tide on AIDS required that we rethink our values, not just our virology. Now it’s time to rethink how we feel about the people suffering from drug and alcohol problems.
03/16/2017 Bill GardnerFrom Science, Donald Trump’s first budget for research:
President Donald Trump’s first budget request to Congress, to be released at 7 a.m. Thursday, will call for cutting the 2018 budget of the National Institutes of Health (NIH) by $6 billion, or nearly 20%, according to sources familiar with the proposal. The Department of Energy’s (DOE’s) Office of Science would lose $900 million, or nearly 20% of its $5 billion budget. The proposal also calls for deep cuts to the research programs at the Environmental Protection Agency (EPA) and the National Oceanic and Atmospheric Administration (NOAA), and a 5% cut to NASA’s Earth science budget. And it would eliminate DOE’s roughly $300 million Advanced Research Projects Agency – Energy (ARPA-E).
This is absurd. The US Congress hasn’t passed a budget since 2009, but if by some miracle it does in 2017, it will not include a 20% decrease in the NIH budget. Does the President understand that the Congress will not do this? Does he even know that his budget says this?
Rotten, J., et al. (1979)
Well, someone in his office wrote these numbers down. What point was that person trying to make? Consider the budget not as a plan for governing but as an artistic performance, a kind of Sex Pistols track from the alt-right, a scream of anger against the dull conformity of funding research into health and well-being.
What values are being expressed?
What does the administration value? The US government spends $3 million on each weekend Trump spends in Palm Beach. That will come to $130 million per year at the current pace. An average NIH R01 grant costs $500K. The President’s weekly resort trips cost us 260 medical research projects, per year.
11/09/2015 Bill GardnerTIE readers know about Anne Case and Angus Deaton’s paper reporting that middle-aged white Americans are dying at an accelerated rate (if not, follow the link or read Austin). There’s currently a nifty debate about the statistical underpinnings of Case and Deaton’s estimates (see Andrew Gelman and Deaton’s reply).*
But there’s an important point being missed. We’re not doing much about the causes of mortality that Case and Deaton highlight.
Case and Deaton found that
three causes of death… account for the [increase in] mortality… among white non-Hispanics, namely suicide, drug and alcohol poisoning (accidental and intent undetermined), and chronic liver diseases and cirrhosis.
They illustrate the increases in these causes in this Figure:
Increasing mortality from 1999-2014, by cause of death.
Case and Deaton believe that the increases in suicide, substance abuse, and liver disease are related to a concurrent epidemic of pain (Richard Friedman argues that misuse of opioids in pain control is an important part of the explanation).
In looking at these death rates, think about not just the suffering of the victims preceding these deaths, but also about what their families went through, before and after the deaths. Moreover, if 30 poisonings / 100,000 people doesn’t sound like a lot, consider that
for each prescription painkiller death in 2008, there were 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse, 130 people who were abusers or dependent, and 825 nonmedical users.
Similarly, the CDC reported about 30 suicide attempts for each completed suicide in 2013.
Case and Deaton claim that the increased mortality among middle-aged whites is comparable to the total mortality of AIDS:
If the white mortality rate for ages 45−54 had held at their 1998 value, 96,000 deaths would have been avoided from 1999–2013, 7,000 in 2013 alone. If it had continued to decline at its previous (1979‒1998) rate, half a million deaths would have been avoided in the period 1999‒2013, comparable to lives lost in the US AIDS epidemic through mid-2015.
These specific numbers will likely be revised as the data are studied further. Nevertheless, suicide, substance abuse, chronic pain, and alcohol-associated liver disease are enormous public health problems, and they are getting worse for a large component of the population.
So what are we doing about this? As was the case for HIV infection early in the AIDS epidemic, we need a better understanding of the social determinants of these problems and we need much better treatments. America made a large investment in AIDS research, chiefly through the NIH, and achieved both of these goals.
But look at the history of NIH funding since 1999 in the institutes most relevant to these problems.
Percentage change since 1999 in funding for NIH institutes.
Using data from the American Association for the Advancement of Science, I’ve graphed funding for the NIH Institutes concerned with Mental Health (NIMH), Alcoholism (NIAAA), Drug Abuse (NIDA), and Arthritis and Musculo-Skeletal Diseases (NIAMS, because much pain treatment is associated with these diseases). I took the constant-dollar funding for each year and expressed it as a percentage of the institute’s funding in fiscal year 1999.
Here’s the key point: We’re losing many lives to suicide, alcohol, drug abuse, and chronic pain. Since about 2004, we’ve been spending less trying to understand why it’s happening and how we can treat it. As Aaron argues here, there are societies that have turned the corner on problems like suicide. There is no excuse for despair.
*It’s a tangent, but this debate illustrates how electronic media benefit science. If the back and forth between Gelman and Deaton had been confined to academic journals, as it would have been just a few years ago, it would have unfolded over months or years. On blogs and twitter, there’s been real progress in just days. Aaron discussed whether such a provocative paper ought to have appeared in one of the premier medical journals. That may not matter as much as it used to.
04/24/2015 Bill GardnerNewt Gingrich is calling for the doubling of funding for the National Institutes of Health.
when it comes to breakthroughs that could cure — not just treat — the most expensive diseases, government is unique. It alone can bring the necessary resources to bear… And it is ultimately on the hook for the costs of illness. It’s irresponsible and shortsighted, not prudent, to let financing for basic research dwindle.
I have argued that prudence requires increased NIH funding here, here, here, here… So I agree with Gingrich, up to a point.
But as Yuval Levin pointed out in 2007, the NIH budget was doubled from 1998 to 2003 and the results were in many ways disappointing. The rapid funding growth was followed by an abrupt stall.
The glut of graduate students enticed by the growing support a few years ago have since found it difficult to get their own work funded once they finished their training, and the sudden deceleration in funding has left many researchers feeling slighted even though their funding grew by leaps and bounds in the past decade. Slower growth over a longer period would have offered a far more stable and sustainable means of expanding the American biomedical research enterprise.
Moreover, Levin correctly noted that Congress missed the opportunity to overhaul
the agency’s exceedingly inefficient and bulky institutional structure [27 separate Institutes], which both wastes resources on needless duplication of administrative overhead and is so specialized that it creates overly rigid and nearly permanent channels of funding.
So if you were redesigning the NIH, what would you do? Here are four proposals:
There are many other issues. Did the recent reform of peer review succeed? Are you satisfied with the system of paying indirect costs on extramural grants? Should we have more support for scientific careers and less for specific projects, or the reverse?
I know you have better ideas than I do. Put your ideas on Twitter using the hashtag #NIHreform. Maybe Newt will chime in.
h/t to Ramesh Ponnuru for the link to Yuval Levin.
10/21/2014 Bill GardnerThe CDC is the US public health service that is primarily tasked with protecting the nation from epidemics. But the NIH matters too because it develops vaccines to prevent the spread of epidemics and therapies to treat the infected. So in the light of Ebola, we should reflect on the value of NIH research and on what it costs.
Francis Collins, the Director of the NIH, made a controversial claim that
“…if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.”
But as Michael Eisen and Sarah Kliff argue, Collins can’t claim that there would have been a vaccine if only we had had more funding. Kliff:
Collins’ statement… irks scientists [because it conveys] certainty, the idea that if only more money had been spent, we’d likely have a vaccine by now. They know that’s not how vaccine development works. Scientists don’t get to name a price for the development of a vaccine — the science is just too uncertain.
Put another way: if it’s so easy, why is there still no effective HIV vaccine?
Eisen believes that Collins could have made a stronger case for funding the NIH: Basic research is essential for coping with novel pathogens.
Collins should be out there pointing out that the reason we’re even in a position to develop an Ebola vaccine is because of our long-standing investment in basic research, and… by having slashed the NIH budget…, we’re making it less and less likely that we’ll be equipped to handle… future challenges to public health. (emphasis added)
For example, when AIDS appeared we didn’t know that HIV existed, let alone how to treat it. Scientists were able to identify the pathogen and develop treatments because the cancer research community had achieved a deep understanding of retrovirus biology. Retroviruses were, at the time, a relatively recondite topic with no evident application to a highly lethal and communicable disease. My friend David States (@statesdj) recalls that:
Gallo and Montagnier [the co-discoverers of HIV] were both retroviroligists funded for work on cancer viruses. If their labs were not already highly skilled in identifying and culturing retroviruses, and the lentivirus family had not already been characterized, it would have taken at least a year to develop the necessary skills and technology to detect HIV, diagnostic tests would have been similarly delayed.
Let’s accept David’s guess that funding of research on retroviruses sped up the development of a medical treatment for HIV by a year. What was the benefit of saving a year in drug development?
There is no easy answer, because the dynamics of the AIDS epidemics depend on many factors. However, I think we can find a plausible lower bound on the benefits of accelerating treatment research by a year as follows.
The rate of new HIV infections in the US has stabilized at about 50,000 cases per year, so the principal benefit of getting treatment a year earlier is that effective drugs were available to an additional 50,000 HIV+ people. (Unfortunately, not all of them get them, but that’s a discussion for another time.)
Moreover, Goldman and his colleagues estimate that early treatment of HIV using highly active antiretroviral drugs has prevented 13,500 new infections per year since 1996. So, another benefit of getting an effective treatment a year earlier is an additional 13,500 HIV- people.
AIDS is expensive, so preventing HIV infections also saves a lot of money. The CDC estimates that the costs of the new infections that occur in the US in just one year, summed over the lifetimes of all the newly infected patients, will be $16.6 billion. So the lifetime health care costs of a single infection will be about $330,000. If so, just one additional year of effective treatments will save the US about $4.5 billion dollars by preventing 13,500 infections. That $4.5 billion is 15% of the $30 billion annual NIH budget.
Funding basic research at the NIH helps protect Americans and others against the risk of emerging global epidemics. Even obscure health research saves lives. The 10-year slide in the NIH budget has been penny wise but pound foolish.
10/15/2014 Bill GardnerThe US has reduced its commitment to health research. The decline in support for health research has many consequences, none of them good. One consequence may be to concentrate health research funding in a small number of institutions.
You can see the overall decline in this graph (from Harvey Fineberg):
The recent history of NIH funding.
The next graphs describe the trend at Johns Hopkins University (from grantome.com).
The upper left graph presents counts of R01 grants — the principal NIH research grant — given out since 1985. The upper right hand graph shows the trend for Hopkins. The absolute number of R01s going to JHU has recently declined, mirroring the overall trend.
Now Hopkins is a special case: it receives more R01s than any other university or hospital (2.4% of all R01s). The graph on the bottom shows that despite the absolute decline, JHU’s R01 share has been steady for a long time. Grant competitions are zero-sum games and Hopkins is holding its own against the competition.
There is an interesting trend in the relative positions of the top 100 universities dominating biomedical research.
The association between proportions of R01s and change in proportions of R01s.
The vertical axis is the proportion of the total R01s received by an institution in 2013. The horizontal axis is the rate of change in that proportion, with institutions that have increased their share of funding to the right. The vertical axis is the change from 2010 to 2013 in the proportion of graphs held by the institution. The folks at grantome.com interpret this as showing that the rich are getting richer.
You have probably noticed a problem with this graph. To show that the rich are growing richer, grantome.com ought to have looked at whether the proportion of grants held in 2010, not 2013, was associated with the change from 2010 to 2013. But let’s suppose that the corrected graph would show something like the above pattern: that the institutions that already have the most grants are increasing their shares of the R01 funding.
Why would that happen? Researchers get a lot of advantages from being at a research-focused school or hospital. Biomedical research is multidisciplinary and at a big shop it’s easier to find highly talented specialists with the skills you happen to need on your research team. Big research factories may provide better mentorship for junior researchers. Conversely, many of these schools ruthlessly cull faculty who lose grant competitions. As funds dwindle and the competition gets more intense, perhaps these advantages become more important.
The change in funding in the 50 institutions with the largest share of R01s in 2013.
Is the concentration of the grant wealth in fewer hands good or bad for science? I have no idea. Maybe the most efficient way to carry out biomedical research is to have a relatively few large super-universities
But if you look at the graph of the 50 most successful universities, something else leaps out. 42 of the top 50 are in ‘blue states’ (that is, carried by Obama in 2012), including the top 13. Most of these top schools have seen an increase in their R01 share since 2010. Five of the 8 red state schools have seen a decline in the proportion of R01s they received.
This isn’t because Obama has steered funding towards ‘his’ states. I’ve served on many NIH grant review committees. Politics never comes up.
More importantly, the pattern can’t have much to do with contemporary politics. The advantage held by northeastern and west coast schools has been around forever. It stems from — but also partially explains — the historical economic advantages of the blue states. You can see the geographical disparities in scientific achievement in other data. Richard Florida mapped the per capita distribution of scientific citations.
Rates of citations of scientific articles, mapped by the location of the author.
The colored peaks are concentrations of scientific productivity. Thomas Friedman had claimed that the world is flat: you can live anywhere and be part of modern scientific culture. Florida showed that this is absurd: the scientific world is spiky. Post-war global science has been led by the US, but not really. It’s been dominated by Massachusetts, the Washington-NYC corridor, and California.
Here are my concerns about the rich getting richer. First, increasing concentration of science on the coasts will increase US regional economic and educational disparities. Red state members of Congress cutting the NIH are hurting their constituents’ children. Second, a greater concentration of scientific dominance in a few liberal states is to the disadvantage of the NIH, because over time it must further erode broad political support for medical science. And what diminishes the NIH is greatly to the detriment of the nation as a whole.
h/t to David States (@statesdj), where I first learned about the grantome.com site.
04/17/2014 Bill GardnerRecent US government budgets have harmed the National Institutes of Health. But the problems in the medical research system are deeper than just the current budget. If you care about medical research, read this article in the Proceedings of the National Academy of Sciences by Bruce Alberts, Marc Kirschner, Shirley Tilghman, and Harold Varmus.
Alberts and his colleagues describe a hypercompetitive culture in science that undermines the process of discovery.
Competition… has always been a part of the scientific enterprise, and it can have positive effects. However, hypercompetition for the resources and positions that are required to conduct science suppresses the creativity, cooperation, risk-taking, and original thinking required to make fundamental discoveries… biomedical scientists are spending far too much of their time writing and revising grant applications and far too little thinking about science and conducting experiments.
You probably expect that the next sentence will be, “So give us more money.” But that’s not where they go.
We believe that the root cause of the wide-spread malaise is a longstanding assumption that the biomedical research system in the United States will expand indefinitely at a substantial rate. We are now faced with the stark realization that this is not the case.
Assuming that science will expand forever, senior scientists have trained far more junior scientists than the system can support, leading to hypercompetition.
The mismatch between supply and demand can be partly laid at the feet of the discipline’s Malthusian traditions. The great majority of biomedical research is conducted by aspiring trainees: by graduate students and postdoctoral fellows. As a result, most successful biomedical scientists train far more scientists than [there are] relevant positions in academia, government, and the private sector.
The overproduction of new scientists is driven by “perverse incentives”:
Salaries paid by grants are subject to indirect cost reimbursement, creating a strong incentive for universities to enlarge their faculties by seeking as much faculty salary support as possible on government grants. This has led to an enormous growth in “soft money” positions, with stagnation in the ranks of faculty who have institutional support. The government is also indirectly paying for the new buildings to house these scientists by allowing debt service on new construction to be included in its calculations of indirect cost recovery.
Alberts et al. have detailed suggestions for reform. They write
(i) to advocate for predictable budgets for US funding agencies and for an altered composition of the research workforce, both with the aim of making the research environment sustainable; (ii) to rebalance the research portfolio by recognizing the inertia that favors large projects and by improving the peer review system so that more imaginative, long-term proposals are being funded and scientific careers can have a more stable course; and (iii) to encourage changes in governmental policies that now have the unintended consequence of promoting excessive, unsustainable growth of the US biomedical research enterprise.
I cannot overstate how distinguished these authors are, both as researchers and institutional leaders in science. Alberts made discoveries in how chromosomes replicate during cell division, is the former editor of Science, and former President of the National Academy of Sciences. Kirschner made discoveries in developmental biology and is a University Professor at Harvard, where he served as chair of the departments of systems biology and developmental biology. Tilghman made discoveries in gene regulation and is the former President of Princeton. Varmus won the Nobel Prize for discovering retroviral oncogenes. He is the former director of the NIH, former President of the Memorial Sloan-Kettering Cancer Center, and the current director of the National Cancer Institute.
Get it? It’s as if the Pope and three leading cardinals held a press conference predicting the collapse of the Catholic church. These people know what they are talking about and we need to listen.
03/07/2014 Bill GardnerPresident Obama has proposed a budget for the US government for 2015. I have previously criticized the federal government’s declining funding for the National Institutes of Health. Recent years have seen 5% decreases in federal funding for health research. Reducing our investment in medical science is unwise, because we face significant health risks and because historically, health research has paid for itself many times over in the value of improved longevity and quality of life.
So, what is the funding for health research in Obama’s 2015 budget? It’s been reported that NIH funding will increase in 2015. Yes. By 0.2% in current dollars. Funding is down for the Institutes of Dental Research and Diabetes and Digestive and Kidney Disease. Funding is constant for the Eye Institute, Child Health, Environmental Health, Aging, Arthritis and Musculoskeletal and Skin Disease, Deafness, Alcohol Abuse, Nursing, the Genome Institute, and Minority Health. There are small increases for the other Institutes and a significant bump for the National Library of Medicine, which is devoted to health information technology research.
However, the Federal Reserve expects 1.5% to 2.0% inflation in 2015. It’s reasonable to use 2.0%, because inflation is always higher in the medical sector, and that is where the NIH buys things. Factoring this in, funding will decline for the NIH as a whole and for every NIH Institute except the National Institute of Mental Health, the National Center for Advancing Translational Sciences, and the National Library of Medicine.
This decline is consistent with what was agreed to by Senator Murray and Representative Ryan in their budget deal, which averted the disastrous consequences of the sequester for health research. Cutting health research is nevertheless short-sighted.
For the sake of argument. let’s suppose that there was nothing else in the budget that could be cut and no additional revenue that could be raised. So spending more on medical research just adds to the debt that must be paid by us and our children. It’s still a good deal — particularly for those children. As Harvey Fineberg explains, our children will gain improved longevity and quality of life, the value of which will likely greatly exceed the cost of financing today’s research.
While the United States must come to grips with its crushing debt burden, and the costs of health care are no small part of the problem, mindless reductions in scientific research are not a sensible part of the solution. The monies spent on delivering health care should not be confused with investments in research to improve health. The next generation bears the burden of today’s debt, yet the next generation also stands to be the beneficiaries of today’s research investments. If there is any area of government expenditure that passes a moral test of justified borrowing from the future to finance work today, it is scientific research.
We should be growing medical science by investing in research. Instead, we continue to shrink the federal research enterprise. So Obama’s 2015 budget is still a disaster, just a smaller one.
