In this blog, we've explored the issue of NIH funding twice. The first time, we examined the reported fiscal spending numbers (here) and the second time, we examined funding by program areas (here), but now we have the budget/deficit ceiling debate, and yet we still see examples of truly nonsensical arguments about NIH funding.
Let's acknowledge at least one thing: It makes no sense to fatten the NIH basic research pipeline when we know FDA can never keep up with it. It's akin to putting up a larger water tower in the hopes of getting more water to the townspeople when you have done nothing with the maxed-out spigot at the bottom of the tower.
Still, some pout and stomp for more. For instance, the Federation of American Societies for Experimental Biology (FASEB; Bethesda, Maryland) has demanded that the NIH budget be increased to more than $35 billion (here).
The explanation for this demand is that in just two years, NIH had spent almost all the $10 billion in additional funding provided by the American Recovery and Reinvestment Act of 2009 and that the additional money is needed to keep some NIH programs running. So instead of advising NIH to learn to stretch a buck, FASEB's president, William Talman, MD, told Congress that a failure to increase NIH spending would be “damaging to our country's future.”
Damaging to what? Damaging to the pipeline of yet more cancer therapies that will wash out of the system without having cured a single patient?” Or is the real damage that Sen. Arlen Specter got another $10 billion for the National Cancer Institute to treat his pet disease? Specter said at the time that he thinks “its scandalous that we haven't done more to cure cancer.”
But let's check the numbers further. At clinicaltrials.gov, you can find in excess of 30,000 trials for cancer. How many for Alzheimer's, which will cost society several times more?
Less than 1,000.
So Specter's attitude is that $8 billion a year for cancer at NIH is scandalous. I agree. It is scandalous when spending on Alzheimer's research is far less but will cost society much, much more. We should also ask ourselves, “what if every condition acquired by a member of Congress got another $10 billion over two years?”
Here's a Jan. 6, 2010, explanation of the return on investment for cancer research at freakononomics.com. The author, Stephen Dubner, acknowledges that age-adjusted mortality for cancer is flat over the past 40 years, but he correctly points out that those cured of heart disease sometimes go on to contract cancer, thus distorting the mortality numbers. However, he does not claim that the greater number of diagnoses explains the flat mortality numbers.
Dubner quotes a source as saying that “between 1988 and 2000, life expectancy for cancer patients increased by roughly four years, and the average willingness-to-pay for these survival gains was roughly $322,000.” The improvements in cancer treatment over those four decades have “created 23 million additional life-years and roughly $1.9 trillion of additional social value, implying that the average life-year was worth approximately $82,000 to its recipient,” Dubner states.
Guess what. The recipient didn't pay the entire $82,000 for each of those four years. They paid a little of it and the vast majority of it was paid by the other people. Who isn't willing to run up a tab of more than $300,000 for four additional years when you know good and well it won't come out of your pocket? And who in their right mind wants to die?
In this economic predicament, we had better start thinking about a GDP argument for further increases in NIH spending. Otherwise, 22nd Century history books will tell the tale of an American economy that went bankrupt curing people so they could retire with no money or return to work in an economy that had no jobs. Makes a lot of sense, doesn't it?
The best way to get run over by a runaway train is to ignore it. We in the U.S. have grown more than fond of ignoring runaway trains. It's almost a national fetish. We're ignoring the massive locomotive of costs associated with Alzheimer's and pretending that cancer kills more people than heart disease. Then we want to engage in the kind of touchy-feely stupidity that goes with asserting the need for more for NIH when FDA is getting less?
I get it. Why use the old gray matter when just switching off the brain and using our feelings is so much easier?
We have to grow up about healthcare spending and how it crowds out other investments or we are fiscally doomed. One way we can show we've grown up is to start talking about the return on investment from additional spending at NIH, or at least for specific areas of NIH spending. Otherwise, we're just sucking our thumbs while sitting on a train track.