American Gastroenterological Association - Advancing the Science and Practice of Gastroenterology

Why Is Long-Term Government Funding for Biomedical Research So Critical?

by Nicholas O. Davidson and David A. Brenner

The images portrayed of biomedical research through the popular press seem to be sending a mixed message about the value and future of this critical enterprise and the role of government funding. On the one hand, we have a complete catalog of the human, mouse and fly genomes and a decade ago we were promised great advances and insights into the genetic basis of human disease. The realization 10 years on that this is a bit more complicated than was first imagined has now led to expanded efforts to understand genetic-environmental interactions and to look outside of the human genome for factors that modify our own intrinsic genetic program. No one doubts the value of biomedical research from an intellectual standpoint, but assigning a real-life dollar value to this effort somehow engenders a sort of good-news (potential breakthrough), bad-news (high cost) scenario that is difficult for the public and for politicians to grasp.

Coupled to this discussion is the realization that the vitality of biomedical research is intimately connected to long-term government funding, particularly, although not exclusively, NIH. The softening of the research mission that followed doubling of NIH funding through 2003 was to some extent attenuated by the American Recovery and Reinvestment Act (ARRA) initiative, but those funds will disappear by the end of 2011 and we will likely witness further contraction in the biomedical research enterprise as a result of greater competition for limiting funding. There will always be fluctuations in NIH funding, of course, but the current climate for academic medical centers and increasing pressure on health-care budgets both locally and nationally make it more important than ever that long-term funding for biomedical research is maintained.

Here we review the top ten reasons why long-term funding for biomedical research is so critical.

1. Predictable, sustained support critical to ensure junior faculty see a viable future for an academic career. We see several phases in considering the future of academic medicine. In the short term (three to seven years), academic medicine is built on a foundation of talented junior faculty who will chose careers that allow them to pursue basic, translational and clinical research. Junior faculty populating academic departments will become the pillars of the biomedical research mission, but their commitment is tied to a viable vision of funding for their career.
2. Following from No. 1, long-term support is essential to ensure a continued pipeline of students who will populate our academic centers in the longer term (seven to 15 years). The junior faculty members who recruit, teach and mentor students play a vital role in attracting the best of these students to careers in biomedical research. Without this homegrown pipeline, biomedical research will depend increasingly on foreign-trained students who, while often outstanding, are less likely to stay and return the investment in their training locally.
3. Important to emphasize that even small (but predictable) investments (e.g. career support) in biomedical research yield high return on investment. There is abundant evidence that government investment in training grants, loan repayment and career development awards is a vital piece to sustaining the academic enterprise and ensuring a cadre of researchers, particularly of physician-scientists, who will facilitate translational research in the coming decade.
4. Government support of biomedical research provides underpinning for training health-care professionals. The vitality of health care in the U.S. is dependent on intimate and sustained interactions between teaching and discovery. Our medical, dental, nursing and other health-profession schools cannot retain their pre-eminence in the absence of sustained support for biomedical research .
5. Predictable support is crucial to ensure vitality of clinical research, particularly transition from T2 into practice-based translational investigation and eventually into community and public-health aspects of digestive and liver disease (i.e. T3 and T4). Translational research, clinical trials and the integration of clinical research into practice and community settings require an elaborate and sophisticated infrastructure, which is simply not amenable to dismantling and reassembling in response to funding fluctuations.
6. Following from No. 4, long-term government support of biomedical research is essential to maintaining the vitality and evidence-based foundation for clinical practice. Without oversimplifying the debate on health-care costs, it is clear that we must optimize expense control and use comparative effectiveness research to inform practice patterns. Government has a unique and vital role in coordinating this mission — we cannot leave it to insurance companies. 
7. Only government-funded research provides unbiased support for research in controversial or basic research. While it is clearly important to recognize the importance of pharmaceutical support and funding of clinical trials, such support is target-oriented and product-directed. Among the key findings from the human genome project are that copy number variation or regulation of completely unanticipated genes play a vital role in diverse diseases. Further, it is clear that NIH funded research has made major contributions in the way that patients are cared for, and has led to improvements in the quality of care and mortality for a number of diseases. Only government can support such endeavors to uncover their potential importance. 
8. Only federal government funded research provides sufficient indirect costs to support the research enterprise. The academic research mission is under perpetual siege in part because of the challenges for medical centers to maintain state of the art practice standards while simultaneously attempting to advance the frontiers of biomedical research. This mission can only be sustained through indirect cost recovery — and even then only partially. Government-academic partnership is essential to this broad mission and is completely dependent on a long-term bilateral commitment.
9. The unique interaction between federal government funding agencies and academic medical centers is required for the U.S. to continue as the world’s leader in biomedical research. U.S. governmental funding of biomedical research has and will continue to lead to fundamentally important advances in the care of patients and will save lives and improve outcomes. Many other countries have invested in building their own research enterprises in recognition of the importance of such a mission. Examples include Singapore, China and Japan as well as several countries in Europe. The economic and political ramifications for long-term government support of biomedical research need to be viewed as a national priority.
10. During this financial crisis, with loss of venture capital, government grants in translational research will be required to support new drug and device development. Such discoveries and developments will provide a critical economic engine for long-term investment and, as above, should be viewed as a national priority.