[Sciences/Policy] What does the proposed NIH budget cut will mean for the US biomedical researchers?

This morning, President Trump administration published its blueprint for the 2018 Federal Budget proposal. Among the different news outlets that have been publishing on this news, the Washington Post has provided a clear and concise details on the highlights on this budget (https://www.washingtonpost.com/graphics/politics/trump-presidential-budget-2018-proposal/?utm_term=.e9dadd623102#dept-7).

An important aspect of this proposed budget are the cuts to compensate in the addition of some programs including increased military expenses ($54B) and the first phase of Mexico-US border wall ($1.6B).

Now there were some expected cuts based on the campaign promises but what was certainly the most surprising and unexpected was the whooping 18% cut in the Department of Health and Human Services (DHHS), this include 18% cut in the National Institute of Health (NIH) budget.

IMG_0009

Why does it matter? It is matter because this cut will affect much more than the NIH, it will hurt the whole US biomedical research and ultimately affect how the US stands as a pioneer in finding new cures and treatment.

As a science communicator, I have experienced by interaction with non-scientists how misunderstand how research is done and funded. A common misconception amongst the population is that universities fund research directly from their tuition fees and from states and federal funds, with a virtual unlimited financial supply. Indeed, this is a wrong assumption.

How does biomedical research funding works?
Firstly, universities provide only a limited funding to its researchers. It will fund newly hired faculty appointment via startup funds, propose some intra-mural grants that are modest in size ($10K-$50K) but enough to prime preliminary studies to increase chances to get fundings. Thats what universities commonly propose to their academic researchers.

Then you have foundations, public-private collaborations that can provide small to medium-size grants ($10K-$200K range) rarely exceeding 2 to 3 years of funding. But the lion’s share comes from federal funding agencies. For biomedical researchers, such funds are mostly requested via the NIH, through its different branches. In my cases, most of my research I seek to get funding is through the National Institutes Neurological Diseases & Stroke (NINDS) that funds anything related to brain and brain diseases.

There are different funding mechanisms but the most common sought by principal investigators (PIs, what we usually refers as the faculty-scientist) are the R21 (high risk, small reward grants that are rarely exceeding $275K for 2 years) and the R01 (low risk, high reward grants that have a modular budget of $250K/year for 5 years).

The NIH gets its money from the federal budget, that gets it mostly from taxes and from borrowing from the Federal Reserve. It means your federal income tax withdrawn (as well as the Social Security and Medicare) falls into a big potluck that will fund many programs and departments.

If you judge by the publication records (how many papers the US publish), the US is doing well and the NIH has been doing pretty well indeed if you look by the chart below (source: NIH):

figure-1-nih_papers_per_year

Now we have to put this graph into perspective by taking into consideration the NIH budget and the number of funded research for a similar time interval. Vox  has put a very nice infographic (http://www.vox.com/2017/3/16/14943816/trumps-budget-health-winners-losers) that accounts for these two items and shown below:

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As you can see, the NIH budget has been strongly increasing up to the early 2000s and since has been maintaining a steady-state. We may conclude that the injection has resulted in more publications. The true is it is not. It is the increased number of PIs in the academic research workforce. As you can see, the spike in NIH publication occurred only after the pre-2000’s bump. The increase in NIH funding has by retroactive effect encouraged more scientists into research and therefore increased the publication.

But…..the NIH increased budget means more funds for scientists no?

In fact no. To prove this fact, look at the proposal success rate: we fell from 30.5% to 18.3%. We have indeed the same dilemma than having one pie and guests: how many guests can you feed on a pie. You can reduce the slice to an extent but you reach a point you can go below a certain size. Also the NIH funding mechanism is designed such that only the best and most innovative grants get funded. It is like deciding with of your guest deserve a slice of a pie.

For 100 grants submitted, the NIH will first recruit peer-reviewers considered experts in the field (mostly academics) for a nominal sum (usually just to cover the travel expenses and a small tip for their time spent reading these grants). Please note here you have no distinction between junior and senior PIs, you are competing as a little leaguer against some MLB seasoned World Series champion.

The first phase is what we call “triage”. Out of 100 grants, 50 will get back to their PIs even before sitting on the discussion table because three reviewers concluded that it was not enough. The other 50 are brought into discussion and scored. Based on their final score and ranked. In the NINDS, the average success rate is about 14%. This means only 14 of these grants will get a chance to get funded.

If you are a young PI like me and that your grant ended at 18th or up to the 22nd position because you apply for your first R01, so you have the “early investigator” perk. Considering that the R01 is the bread-and-butter for running a lab and the average time between submission and notification is about 6 months, you can easily understand how stressful it can be. Wait it is even more.

In order to increase your odds of funding, you need to show a research productivity by publishing papers. To publish papers, you need to produce data. To produce data, you need to invest in workforce and consumables. To invest into these, you need funding……So you can see how research can become a Sisyphus quest.

Well, a $250K research grant is not bad, no?

To be honest, it is better than other countries but still it can be still stressful. Now you have got funding from the NIH, you think you are rich, huh? Well you are not. First you have to recoup some of your salary. There are some universities, especially high-ranked universities consider that having you on their payroll at a rate of only 50% will give you an incentive to seek funding to run your lab.  Therefore you have to remove a chunk of this salary and benefits (health insurance, retirement…..) from this budget.

Then you need the workforce to run the lab. You need a reliable lab technician ($30K/year with benefits), a postdoc ($60-70K/year with benefits) to have the horsepower to produce data. Then you have to cover costs for consumables, reagents, core facilities use and purchase equipment…..

Over the last 40 years, the average cost of research has doubled, we went from $100’000/publication to over $200’000/publication (using inflation-adjusted grade) according to a recent study by the National Center of Science & Engineering Statistics (https://www.nsf.gov/statistics/2016/ncses16200/ncses16200.pdf).

So you see the situation: You have less funding success per capita (remember the pie?), the cost for research are steadily increasing. And as a scientist, you start to feel like Luke Skywalker inside the trash compactor, waiting for C3PO and R2D2 to stop this march to your death.

But wait, you can do without research in academics and keep your job….

In fact, thats another fallacy around people. When you are hired as a faculty, you are put on probation for 5-6 years. We call it the “tenure-track”. You have to comply in three major areas: teaching, research and (administrative) services. In most Tier 1 and 2 universities, research takes 60% of your appointment, teaching 30% and then service about 10%. But usually, all expect you spend more time so you are ending up working on a 200% pace fit into a 100% allocated time.

You have to show you publish good papers and get good funding, you have good student evaluations and teaching and you can ensure a good service to the university. After 5-6 years, you are set for a Promotion & Tenure packet, that get a recommendation from your Department Chair (yeah or nay), your Dean (yeah or nay), your University (yeah or nay) and finally the Board of Regents (a board composed by members appointed by the state Governor) that will decide if you are a good investment or a dead horse.

Getting tenure gives you a small sense of job security but does not give you research fund to run the lab, your tenure is also evaluated on a regular basis. If you are refused tenure you are out for a job and currently the job market for academic is tough, very tough.

But its only a 20% proposed budget cut, it will be dissolved into the whole NIH

No it will not. The NIH like any administration is acting like a perfect gas: it is incompressible. Well it is, but it will cut where it can: the extra-mural funding (80%). By cutting the extramural funding, it will give less to each branches, these branches will give less to grants and therefore the number of funded grants will decrease.
By estimation, we can realistically think that the NINDS playpen will reach only 10%, that means you will have a higher chance to have your grant graded as excellent but because you are facing fiercer competition, you don’t get funded and have to resubmit it again in 6 months to have a chance to get it funded. A spiral of hell in sort of.
One thing we should learn from this post is that cutting budget in sciences, humanities  and arts never “make a country great again”. It simply make the country worse and may have long-lasting damage.
NIH-funded biomedical research is at the basis of any biomedical innovation. Pharmaceutical companies have no envy or interest to fund basic sciences as they have to make priorities and their budget too. However, the innovation in pharmaceutical companies is driven by discoveries funded by public funds. Cut it from the bottom and I can guarantee the ability to provide new therapies will sink down fast, very fast.

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