An Uphill Battle for Ground Breaking Research, By Troy Chapman

Advocates for health and biomedical discovery would do well to develop and adopt a compelling communication strategy of their own in the face of an uncertain funding climate for the National Institutes of Health (NIH). On August 12th, Senator Patty Murray and NIH Director Dr. Francis S. Collins convened a room full of inquisitive professionals concerned about NIH funding. The message delivered: ‘Funding for NIH faces an uphill battle.’ Senator Murray and Dr. Collins, along with President Michael Young of University of Washington (UW), delivered a compelling case for a sustainable approach to NIH funding that limits fluctuations, while enabling the biomedical revolution to take place in our state and nation.

To kick off the discussion, President Young discussed the benefits to our economy resulting from research and development at the UW. For example, Young cited eighteen different spin off companies utilizing UW developed technology of which one-half are biomedical or biotechnology innovations. He touted that those numbers rank UW in the top two or three nationally. Young praised the spirit of UW and set the stage for Senator Patty Murray stating, “We try to take what we do, to make the world a better place.”

Senator Murray reinforced Young’s remarks by reiterating the importance of biomedical research. Murray explained that continued investment by NIH in life science research is a necessary catalyst for economic growth and global competitiveness as well as sustained biomedical discovery and for the advancement of public health. Federal investment in biomedical research is essential, Murray explained, if we are to continue the biomedical revolution in our state and nation as well as keep pace with the investments—and progress—of other nations. For example, the United States’ investment in non-defense research and development (R&D) spending as a share of gross domestic product (GDP) is seventh from the bottom of the 34 member countries of the Organisation for Economic Co-operation and Development (OECD). The United States’ declining investments in R&D is troubling, especially considering the increasingly aggressive investments of other nations. China, for example, has increased their investment as much 20-25 percent. Recent data shows that China’s spending on R&D will surpass total U.S. spending by 2022.

In Washington State, biomedical research is no less important to our economy and public health. Murray mentioned that NIH invested $835 million in Washington State in 2013, with investments in R&D totaling $475 million per year with over one-half of the $475 million going toward life science research. She explained that the success of this investment is evident when we consider that there are over 1,300 bioscience companies in Washington that contribute billions of dollars to the economy.

Regardless of worthy research efforts, however, the quest for sustainable funding is an uphill battle. Murray contended that the importance of R&D is not reflected in the Federal budget. She warned that despite her successful efforts to form a bipartisan budget plan with House Budget Committee Chairman Paul Ryan—that eliminated some of the sequestration budget cuts impacting NIH—that sequestration will kick in again if elected leaders cannot formulate a deal that replaces sequestration in 2016.

The failure to prioritize federal investment in life science research and development is leading to troubling trends, Murray explained. She cited instances of companies closing their facilities and moving overseas, promising studies getting cut short because of a lack of funding, and bright students opting out of the sciences because of a dearth of opportunities. She proclaimed, “You know, if the United States were a business, investments in future economic growth would be the last thing we would try to cut, and that is exactly what research and development is. It is an investment in future economic growth, and I am determined to make sure we keep up with our global economic competitors.” Senator Murray closed by explaining the need for collaboration, compelling story telling, and advocacy that can shift the debate to ensure that federal investments in R&D and, in turn, future economic growth are not considered a line item in the federal budget that is “ripe for cutting.” Murray continued, “The conversations we are having today are so important. We need to share the incredible success stories that can build broader support for investments in innovation and future economic growth.” She ended on the note that these investments are not only important for our economy, but more importantly for the health and well-being of our communities.

Dr. Collins laid out a compelling narrative and built upon Senator Murray’s message to continue sustainable investment in the NIH. Collins highlighted several public health accomplishments over the last 60 years including a near seventy-percent drop in cardiovascular disease and stroke, a one percent per year decline in the number of cancer deaths over the last fifteen years, and the discovery of HIV antiviral drugs that enable a young person who contracts HIV to have a full life expectancy, as well as the promise of potential cures for HIV and the prospect of HIV eradication. Additionally, he discussed several ground breaking technologies, including immunotherapies that prompt a patient’s own immune cells to attack and kill indwelling cancer cells; and advances in whole genome sequencing that are causing a rapid downward cost curve of the technology—from nearly $100 million per genome in 2003, to as little as $1000 per human genome in the near future.

The Director shared the NIH’s attempt to reduce the bottlenecks that increase the time and costs of bringing treatments to the market. For example, he cited the development of human tissue types using pluripotent stem cells. These 3-D dimensional organoides, made up of ten to twelve tissue types, can then be loaded up to biochips, and hardwired with bionodes that are capable of monitoring cellular responses to various test compounds. Essentially, the biochips are a Fitbit for tissue culture cells. This technology could greatly improve the efficiency of drug screening, while reducing the time and costs of bringing a treatment to market. Additionally, one can conclude, the technology may deliver the added benefit of reducing the need for research with animals by gaining more information than can be accomplished with current tissue culture methods. These examples, both the inspiring and daunting, paint what Dr. Collins called a compelling case for a sustainable path forward for NIH funding.

These advances in biomedicine and technology are incredible and there is more work to be done. Dr. Collins discussed antimicrobial resistant bacteria, which poses a serious public health threat and will require a concerted, collaborative effort from the public and private sector. “According to the Centers for Disease Control and Prevention (CDC), antibiotic resistant infections are associated with 23,000 deaths and 2 million illnesses per year in the United States.” Estimated impacts to the economy range as high as $20 billion in excess direct health care costs, and as much as $35 billion in lost productivity.

In fact, the public health threat engendered by Antibiotic-Resistant Bacteria has forced President Obama’s hand on the matter. On September 18th, President Obama signed an Executive Order and released the National Strategy on Combating Antibiotic-Resistant Bacteria. In addition to the National Strategy, the President’s Council of Advisors on Science and Technology (PCAST) is releasing a report on Combating Antibiotic Resistance, which provides actionable recommendations for researchers and physicians.

The Executive Order directs key Federal departments and agencies to take actions that will combat the growing public health threat and directs federal agencies to implement the National Strategy and to address the PCAST report. According to the White House, “The National Strategy provides a five-year plan for enhancing domestic and international capacity to: prevent and contain outbreaks of antibiotic-resistant infections; maintain the efficacy of current and new antibiotics; and develop and deploy next-generation diagnostics, antibiotics, vaccines, and other therapeutics. The Executive Order: establishes a New Task Force for combatting Antibiotic-Resistant Bacteria; establishes the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria; improves antibiotic stewardship; strengthens national-surveillance efforts for resistant bacteria; promotes the development of new and next-generation antibiotics and diagnostics; and strengthens international cooperation. Additionally, the Administration announced a $20 million prize that will be co-sponsored by NIH and the Biomedical Advanced Research and Development Authority, to facilitate, “the development of rapid, point-of-care diagnostics tests for healthcare providers to identify highly resistant bacteria infections.”

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President Obama’s actions and those of the health care community will be paramount to addressing the public health threat of antibiotic-resistant bacteria. Promising research and the ability to address public health concerns, however, are often delayed due to an uncertain funding climate for life science research. Collins showed the audience a graph depicting the fluctuations in NIH appropriations over the years, which highlighted appropriations variability including a flat line since 2003, and a jarring dip following sequestration. Collins proposed a path forward that allows for long term planning, and explained that had the budget stayed on a 3% growth trajectory since the 1960s we would be essentially slightly better than where we are today, but would have eliminated many of the ebbs and flows that often stifle investments in innovation and research.

Collins concluded that the case for a sustainable and concerted approach to funding the NIH and, thus, R&D is very strong. With sustained investment, society awaits lifesaving cures and technological advancements that have the potential to improve the health care system, lower long-term costs, cure diseases, sustain our economic competitiveness, and improve societal well-being. In addition, investments in biomedical discovery enrich diverse career opportunities for those with scientific training including journalism, communications, education, law, policy and more.

NWABR encourages its readers to take note of the upcoming federal budget debate that will fundamentally determine the path forward for the NIH and life science research. Among many competing priorities, it is clear that federal investment in the NIH and, in turn, biomedical discoveries and innovations deserve high priority. Benefits from research are many, and the costs of a lackluster investment in research are great. Grassroots advocates and supporters of biomedical research should share their compelling stories with their friends and family and engage the community in this discussion. Life science research needs a sustainable and predictable funding climate at the NIH. This mean that the looming threat of sequestration needs to be eliminated by striking a sustainable bipartisan budget that accounts for inflation and growth, while addressing our long-term national deficits. NWABR stands ready to share compelling stories and support the life science research community in this discussion.

Thank you,

Troy Chapman

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