The Trump administration wants to cut billions of dollars from funding biomedical research at the National Institutes of Health. Its unclear if it will be able to, considering how funding for cancer, diabetes, and other disease research tends to have bipartisan consensus, and many prominent Republicans in Congress are opposing the cuts.

The White House has suggested the size of the agencys budget roughly $32 billion in 2016 is the problem. Only in Washington do you literally judge the success of something by how much money you throw at the problem, not actually whether its solving the problem or coming up with anything, Sean Spicer, President Trumps press secretary, said in March, defending the proposed cuts of $6 billion to the 2018 budget. (Theres also talk of slashing $1.2 billion from NIH research grants this year.)

Bu we can judge the success of the NIH by measures other than the amount of money being spent at it. Because for decades scientists have been studying a version of this question: What does public spending on biomedical research actually buy us?

A lot, it turns out. So lets run through some of the evidence. (Many thanks to Matthew Hourihan, R&D budget analysis director at the American Association for the Advancement of Science, who helped compile this research.)

The NIH isnt just a research campus in Bethesda, Maryland. Its the major funder of biomedical research in universities across the country. Around 80 percent of the NIH budget goes to these grants.

Turns out giving money to some of the nations smartest people to answer tough problems in medicine and biology generates some good products and ideas, and stimulates the economy.

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

In March, Science published a study looking at the impact of NIH grants over a 27-year period.

The main finding: 8.4 percent of all NIH grants go on to generate patents for new drugs, medical devices, or other medicine-related technologies.

The authors of the Science paper had previously figured out that a $10 million boost in NIH funding leads to a net increase of 2.3 patents. They estimate, roughly, that each patent is worth around $11.2 million in 2010 dollars. A back-of-the-envelope calculation indicate that a $10 million dollar increase in NIH funding would yield $34.7 million in firm market value, they reported in a recent NBER paper. Not a bad bet.

One single invention can make for a huge advancement in biotechnology. The NIHs most cited patent since 2000 was for a tiny and incredibly important invention: microscopic valves that allow scientists to create circuits of fluid that work kind of like computer chips. According to Battelle, a private research firm, the NIH spent about $500,000 developing these valves. Since then, biotech companies have seized on the invention, creating even smaller versions of chemistry labs that can diagnose diseases like HIV and Ebola (these are sometimes referred to as lab on a chip devices). Its an invention that has spurred a whole new biotech industry and also helps save lives.

2) Those patents then inspire new patents

The Science papers secondary finding is perhaps just as important: Grant money also has a carryover effect into the private sector. Around 30 percent of all scientific papers generated by NIH grants are cited by successful patent applications from private firms.

Which means even if a grant isnt directly generating a patent, it has a good chance of aiding the thinking behind the discovery of another.

And theres some research that suggests government funding is better at kickstarting this virtuous cycle than private sector funding: NIH-funded patents are cited by future patents at double the rate of those developed by the private sectors, a 2014 Nature Biotechnology paper found.

Furthermore, the Science analysis finds that both basic and applied research are just as likely to be cited by future patents. (Basic research seeks to understand the nuts and bolts of biological processes. It answers questions like: How does the retina work? Applied research seeks to generate ideas or products that can be put to use: Can this medical device improve retina functioning?)

That theres parity between basic and applied research means that generating knowledge for the sake of it is just as valuable as designing direct solutions to problems.

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

Again, this means research dollars spent by the NIH inspire other research institutions and industries to spend money on research and development, generating ideas to change and save lives.

Overall, Battelle calculated that every $100 million spent on NIH research leads to an additional $105.9 million in future research and development in both the public and private sectors.

3) Those patents form the basis of new biotech firms

NIH money lands in research institutions all across the country. In 2014, a report in the journal Research Policy asked: What happens to local economies that see that influx of NIH funds?

Quite simply, where NIH funds flow, new biotechnology firms follow. A $1 million increase in the average amount of federal R&D funding associates with an increase of 558 percent in the number of local biotechnology firm births a few years later, the authors reported.

In 2013, the Science Coalition, a science advocacy nonprofit, published a report on 100 companies that got their start because of federal research funds. Most of them are pretty small employing a few or a few dozen people. They produce things like custom strands of DNA for use in genetic engineering, or compounds to make pharmaceuticals more water-soluble.

NIH-funded research has also spurred gigantic new industries. Consider the human genome project, to which genetic testing companies like 23andMe, and the entire genomics industry, owe their existence. The human genome project cost around $3.8 billion. Its estimated to have generated $796 billion in economic impact.

4) All this research gives us drugs that save lives

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

Looking at decades of Food and Drug Administration drug approvals, the researchers found virtually all the important, innovative vaccines that have been introduced during the past 25 years have been created by PSRIs [public sector research institutions].

Their definition of PSRI includes all universities, research hospitals, nonprofit research institutes, and federal laboratories in the United States, so its not just spending by the NIH.

The FDA prioritizes drugs in the approval pipeline based on potential impact. Drugs that began at public research institutions were more than two times more likely to be flagged as high-priority than those that began in the private sector. The analysis found that 46.2 percent of new-drug applications from PSRIs received priority reviews, as compared with 20.0 percent of applications that were based purely on private-sector research, an increase by a factor of 2.3.

And the public sector is particularly good at creating drugs to cure deadly diseases. Of the 153 approvals of drugs that began at public research institutions, 40 were for the treatment of cancer and 36 tackled infectious diseases, the report found.

Specifically, research also finds that spending at the NIH does spur new drug discoveries. A 2012 study found that a 10 percent increase in the funding for a particular disease yields about a 4.5 percent increase in novel drugs entering human clinical testing (phase I trials), after a lag of up to 12 years.

Heres a famous example: In the 1950s and 60s, NIH researcher Julius Axelrods work showed how neurotransmitters function in the brai
n, leading to a Nobel Prize. But more importantly, his ideas led to the drugs we now use to treat depression. All the major SSRIs [selective serotonin reuptake inhibitors] were discovered by pharmaceutical companies with the use of Axelrods basic discoveries, NEJM reports.

The White House believes spending at the NIH has gotten out of hand.

About 30 percent of the grant money that goes out is used for indirect expenses, which, as you know, means that that money goes for something other than the research thats being done, Health and Human Services Secretary Tom Price told reporters, justifying the proposed 18 percent cut to NIH funding for the 2018 budget.

Its true that the NIH also pays for overhead costs like electricity bills and lab equipment. And yes, there are legitimate concerns that these costs can spiral. Stat News has the best explanation of this argument here. In the piece, reporter Meghana Keshavan explains:

Critics suggest that the system gives universities an incentive to bump up their overhead costs, since the reimbursement rates are negotiated based on their previous years spending. So if a school builds a fancy new lab one year, it can claim the need for a higher reimbursement rate the next.

Should universities like Harvard, which have billion-dollar endowments, get federally funded money to keep the lights on?

The Government Accountability Office which analyzes government policies for inefficiencies flagged the potential for sprawling overhead costs at the NIH in a 2016 report, urging the institute to establish programs to better investigate potential fraud and abuse.

So theres some legitimate debate to be had about funding at the NIH. But its also clear that the severe, sudden cuts proposed by the Trump administration will have the immediate effect of stifling scientific progress.

For one, science need stable funding. Projects are funded on a multi-year basis. Yet Congress can change the NIH budget every year if it wants. The instability makes it harder to fund multi-year projects.

And already, competition for NIH grants is intense. Funding has basically plateaued over the past decade, while at the same time the cost of research keeps increasing and an ever-growing pool of PhDs is competing for a relatively smaller pile of grant money.

Consider this: In 2000, more than 30 percent of NIH grant applications got approved. Today, its closer to 17 percent. Its not crazy math: The less money there is to go around, the fewer projects get funded. If the Trump cuts go through, itll likely mean hundreds fewer research grants.

Congress will decide whether to include the immediate proposed cuts to this years budget by the end of April. But enthusiasm so far seems mixed.

When reporters asked Sen. Roy Blunt, a Republican who serves on the Senates Appropriations Committee, if the 2017 cuts could happen, he replied, No. No. Other Republicans are similarly skeptical, according to the New York Times. Rep. Kevin Yoder, a Republican from Kansas, has said, I will fight to ensure that these proposed cuts to medical research funding never make it into law.

But if Congress does vote to cut NIH funding which could very well happen who knows what ideas and breakthroughs well miss out on?

Go here to see the original:
Trump wants to cut billions from the NIH. This is what we'll miss out on if he does. - Vox