Will we cure cancer? Trump rule may grind research to a halt
Dr. Jonathan B. Jaffery
When my wife was diagnosed with breast cancer over Thanksgiving weekend, I took a crash course in relearning all about staging, treatment, management and prognosis. It’s an understatement to say it’s changed dramatically since I first learned about the disease in medical school 30 years ago.
Not only has the death rate dropped by 40%, but the treatment options have improved to decrease the morbidity associated with the care for breast cancer patients. In short, people are living longer, and the side effects of treatment are fewer and less severe.
How did this happen? How can we possibly have seen such incredible improvements in clinical care for a disease that 1 in 8 women get in their lifetime? The answer is biomedical research, including basic science, translational and clinical trials, conducted at universities and academic health systems across the country, and funded largely by the National Institutes of Health and the 72 National Cancer Institute-designated cancer centers and thousands of grantees and clinical trial sites all across the country.
Without that ongoing support, not only for individual trials but for the overall infrastructure to support them, I fear that many of the discoveries and advances would never become reality.
And it’s not just breast cancer that’s seen such incredible advances. In the 1960s, the five-year survival rate for kids with acute lymphocytic leukemia – the most common childhood malignancy – was less than 10%. Since that time, survival rates have steadily improved and now are 90% or greater. This incredible medical success story is due largely to NIH-funded biomedical research conducted in our nation’s universities and academic health systems.
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The list goes on, and not just for cancer. Cardiovascular disease, epilepsy, Parkinson’s disease and countless other conditions all have treatment, management and prognosis that are vastly improved over the past half-century or more, and all through the support of federally funded research via the NIH.
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NIH pulls funding essential for research
Soon, however, all that vital work could be in jeopardy. This month, the NIH announced that it will drastically reduce the support it provides universities and health systems for the costs of facilities and administration (also referred to as indirect costs). That money supports the infrastructure and overhead critical to medical research.
The change is driven by a new Trump administration policy designed to ensure that more federal dollars are used directly for research. A federal judge blocked the policy from taking effect last week and a hearing on the legal dispute is scheduled for Friday.
NIH grants have long included money to help pay for the buildings where research is conducted, the equipment and personnel needed to run increasingly sophisticated labs and the overhead (utilities, cleaning costs and so on) needed to maintain these complex operations.
The use of these funds is heavily audited to ensure it stays consistent with the intended purpose, and rates are negotiated with each institution through a rigorous process and on a regular basis, to account for the individual nature and needs of the work that happens at that institution.
The new method for calculating indirect costs would cut $4 billion of that research support, including funding for clinical trials already underway.
Imagine you or your loved one is enrolled in one of those trials. Last week you received a certain treatment for your cancer or other life-threatening disease. Next week, under this proposal, you may not.
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Research will end if funding change proceeds
Here’s what will happen if this change remains in place. Clinical research trials will shut down. Basic research will grind to a halt. Thousands of people will lose their jobs. States and the federal government will lose tax revenue from those workers. Advances will cease. People will die.
If I sound worried, it’s because I am. I’m incredibly grateful that my wife is getting the excellent care that she is, and that her treatment options are so much better than they were just a couple of decades ago.
Having seen those advances through my own medical career, it’s not hard for me to imagine an alternative reality, one where the NIH didn’t support biomedical research and make the United States the envy of the world for our discovery and medical advances.
In that alternative world, instead of planning for a future full of all the things we hope for our golden years, we’d be planning for something very different. I hope our country maintains its commitment to research and continues to support lifesaving biomedical advances.
Dr. Jonathan B. Jaffery is the chief health care officer at the Association of American Medical Colleges.
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