Are We Sequestering Ourselves to Death?

Critics call the National Institutes of Health bloated. Advocates insist spending cuts are a matter of mortal danger.

US President Barack Obama (R) looks through a microscope at brain cells with Dr Marston Linehan (C) as he tours the National Institutes of Health (NIH) before making a major announcement regarding the American Recovery and Reinvestment Act at NIH in Bethesda, MD, September 30, 2009. Obama announced five billion in grant awards under the American Recovery and Reinvestment Act of 2009 (Recovery Act) to fund cutting-edge medical research in every state across America. AFP PHOTO/Jim WATSON
National Journal
Sophie Novack
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Sophie Novack
Dec. 17, 2013, 1:22 a.m.

Con­gress’s year-end budget deal would blunt spend­ing cuts sched­uled to hit the fed­er­al gov­ern­ment’s premi­er med­ic­al re­search board, but that’s cold com­fort to ad­voc­ates who in­sist the se­quester spend­ing cuts are already put­ting the pub­lic in per­il.

The Na­tion­al In­sti­tutes of Health was on track for an ad­di­tion­al 2 per­cent budget cut come Janu­ary, but the new budget deal would raise the total spend­ing cap on nondefense spend­ing by $22.5 bil­lion, restor­ing about 61 per­cent of se­quest­ra­tion cuts on that side. The spe­cif­ic im­pact on NIH will not be de­term­ined un­til the Ap­pro­pri­ations com­mit­tees de­cide how to al­loc­ate the fund­ing by Jan. 15.

The House voted to pass the le­gis­la­tion Thursday, and the Sen­ate is tent­at­ively ex­pec­ted to do so be­fore leav­ing town for the year.

But while the deal grants some re­lief from spend­ing cuts, the NIH budget will still re­main lower than it would be without se­quest­ra­tion. The in­crease in some dis­cre­tion­ary fund­ing in 2014 does not fully undo the first round of se­quester spend­ing cuts, which amoun­ted to $1.55 bil­lion — 5 per­cent of NIH’s an­nu­al budget — in fisc­al 2013.

Leav­ing those cuts in place is a ma­jor stick­ing point for the in­sti­tutes’ cham­pi­ons in Con­gress. “We’re about to kill the goose that lay the golden egg,” Rep. Jack­ie Spei­er, D-Cal­if., told re­port­ers last Tues­day.

“We have so many great suc­cess stor­ies to point to. To think we are now starving the great in­sti­tu­tion that has borne so much fruit is really quite dis­turb­ing,” Spei­er con­tin­ued, cit­ing the role the agency played in re­du­cing can­cer and heart dis­ease mor­tal­ity in re­cent dec­ades.

But just be­cause NIH’s ad­voc­ates are alarmed doesn’t mean that its crit­ics are happy.

“The NIH budget is huge. I don’t doubt there is a lot of good and use­ful re­search they do. There’s also no ques­tion they lit­er­ally waste mil­lions on stud­ies you can’t call any­thing oth­er than stu­pid re­search,” says Hans von Spakovsky, seni­or leg­al fel­low at the Her­it­age Found­a­tion.

Von Spakovsky says NIH fund­ing should be go­ing to “real re­search,” such as the de­vel­op­ment of new an­ti­bi­ot­ics. He ar­gues the budget cuts should re­fo­cus at­ten­tion to those kinds of grants, and cites re­cent NIH stud­ies — in­clud­ing one at Ohio State Uni­versity on mas­sage ther­apy in rab­bits, and one at the Uni­versity of Cali­for­nia San Fran­cisco on the role of breath­ing in med­it­a­tion — as ex­amples of waste­ful re­search spend­ing.

“I don’t see any reas­on for se­quest­ra­tion cuts to be re­stored,” he says. “They haven’t shown any ac­know­ledg­ment or plan to stop giv­ing to ri­dicu­lous stud­ies.”

The NIH budget de­bate is part of the lar­ger budget battle over the se­quester. Those more sym­path­et­ic to gov­ern­ment spend­ing in­sist the cuts are erod­ing the build­ing blocks of eco­nom­ic growth and na­tion­al well-be­ing, but do­ing so in a way that’s not im­me­di­ately ob­vi­ous. Spend­ing hawks are say­ing the dam­age is not ob­vi­ous be­cause, by and large, it’s not oc­cur­ring at all.

Car­rie Wolinetz, pres­id­ent of United for Med­ic­al Re­search, a co­ali­tion of re­search in­sti­tu­tions and pa­tient and health ad­voc­ates, says the budget cuts pre­vent NIH from con­tinu­ing the full ex­tent of its life-sav­ing re­search.

The group launched a series called “Se­quester Pro­files: How Vast Budget Cuts to NIH Are Plaguing U.S. Re­search Labs” to em­phas­ize the im­port­ance of med­ic­al re­search and the dam­age se­quester cuts have on NIH’s pro­gress.

Ad­voc­ates name lim­ited med­ic­al in­nov­a­tion, delayed re­search, loss of jobs, and de­creased in­ter­na­tion­al com­pet­it­ive­ness as harms of the agency’s cuts that were im­ple­men­ted this year.

UMR notes that in 2012 alone, NIH fund­ing sup­por­ted more than 402,000 jobs and $57.8 bil­lion in na­tion­wide eco­nom­ic out­put. NIH es­tim­ates that 640 few­er re­search pro­ject grants will be awar­ded in FY 2013 com­pared with 2012.

“One of the things most re­spec­ted throughout our work is the con­tri­bu­tion we’ve made to the rest of world,” said Dr. Don­ald Small, dir­ect­or of the Pe­di­at­ric On­co­logy Di­vi­sion at Johns Hop­kins Uni­versity School of Medi­cine Sid­ney Kim­mel Com­pre­hens­ive Can­cer Cen­ter. “We’re wor­ried we’re los­ing that lead­er­ship right now, along with all the jobs that go with it.”

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