On March 7, 1995, 26 members of the cardiovascular research community and five patients joined forces with the American Heart Association (AHA) and committed their time and their resources to travel to Washington, DC, to lobby. And it was a real commitment; they had to prepare, to volunteer their time, and to spend their own monies for travel and lodging. It is precisely this type of commitment that will be needed to counter—or at least limit—the application of severe cost-cutting strategies that have been proposed for the National Institutes of Health (NIH) as a whole and the NHLBI (National Heart, Lung, and Blood Institute) and NINDS (National Institute of Neurological Diseases and Stroke) in particular. President Clinton’s budget for 1996 proposes a 4.1% increment for NIH, with respective increments for NHLBI and NINDS of 3.1% and 3.0%, which are well below the biomedical inflation index of 4.3%. However, the mood of Congress is far more restrictive, with some of the members proposing cuts of as much as 10% (the president appears to be proposing cuts over a 5-year period that might end up being as severe).
The crisis in biomedical research funding has been growing for many years. Perhaps the most telling statistic in terms of its impact on the scientific community and on the performance of investigator-initiated science relates to the funding of new and competing RO-1 grants and New Investigator awards. For all of NIH, during the 5-year period after 1988, RO-1 funding decreased from 5170 to 4121, and New Investigator grants decreased from 695 to 505. The loss of research grants and of replenishment from the pool of young investigators is obvious. The success rate of applications when initially submitted (as new grants or competing renewals) was 15% in 1994; the eventual success rate, after submission of one or more amended applications, was 26%. This translates into more time spent preparing grants, reviewing grants, and spending months to years waiting for funding. No wonder the community is depressed; no wonder the attractiveness of the sciences is dwindling for our young people; and no wonder the scientific effort of the country is threatened.
And no wonder 26 people went to Washington; the wonder is that more did not go. Those involved in this effort confronted a broad array of opinions among the senators, congressional representatives, and aides. All supported a strong NIH. But few reflected the view of earlier years, that they would fight for and probably win more monies for NIH. The more prevalent view was that the best they could do was to avoid cuts—or at least deep cuts. The most strident view was that cuts of as much as 10% could be seen.
Since our visit, the House Budget Committee has proposed legislation (HR 1219) that will reduce discretionary spending caps by $100 billion over the next 5 years. These reductions are measured from the fiscal year 1995 level and will result in real cuts in spending. For the NIH, a reduction of $2.5 billion over the next 5 years was recommended to meet Contract With America requirements. Under this proposal, NIH will have the flexibility to prioritize this reduction in spending. This proposal is only part of an illustrative list of discretionary spending cuts that the House Budget Committee has suggested to show that a $100 billion cap reduction is achievable. These suggestions are not binding on other House committees, including appropriations and various authorizing committees, that are responsible for deciding how to implement these cap reductions. Furthermore, the illustrative spending cuts are not included in the legislation that actually lowers discretionary spending caps. Nevertheless, any suggestion that responsible members of Congress are willing to propose such massive spending cuts for NIH is a threat that should be taken seriously.
Our discussions with members of Congress and their staffs led to a consistent set of questions. “Since the NIH has gotten increases every year, while other agencies have been cut or eliminated, how can you justify more spending?” “Doesn’t more research mean higher health care costs?” “Can’t some of this be privatized?” “What programs should we cut to increase the NIH’s share—There will be no new money” “Why don’t we hear from you more often? The other health groups seem to be here all the time, but we hear very little from Heart.”
We came away from Congress chastened, feeling that we had made a good case but understanding that without constant effort by a far larger cohort, our message will soon be lost. We urge each of you to respond to the crisis. The months of April and May are the ideal time to contact your senators and representatives. The best contact is face-to-face, often with a staff member. We need to deliver our message over and over again. Federally funded biomedical research is critical for the health of the nation, and the NIH is the only agency that can deliver this vital product. Our world leadership in the biotechnology and pharmaceutical industries and the very future of US medicine are at stake. We cannot state the message strongly enough; the threat of cost cutting is real, it is imminent, and it will cripple the nation’s biomedical research effort for years to come. It needs your instant and consistent effort and attention, and the need is now.
For further information about how to contact your representatives or senators and for further details of the AHA public policy message on biomedical research, please contact your AHA affiliate or the AHA Office of Public Affairs at 202-822-9380, fax 202-822-9883.
- Copyright © 1995 by American Heart Association