publication date: Oct. 31, 2014

The Impact of Triple Calamities: Flat Funding, the End of ARRA, & a Loss of Purchasing Power

Reported by Matthew Bin Han Ong

The Cancer Letter asked leaders of cancer centers, professional societies, and science advocacy organizations to comment on declining levels of NIH and NCI funding at freestanding cancer centers and selected academic institutions that include cancer centers.

Their responses follow:

  

Kevin Cullen, director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center

“I think the changes in funding you show here are very troubling and in some ways ominous. Many of the best cancer centers in the country have seen large decreases in their NIH and especially NCI funding in the last 5 years. Adjusted for inflation, the numbers are even worse.

“While the impact of these reductions at an individual center may be moderate or large, the impact across the totality of NCI designated cancer centers is huge.

“A tremendous and productive national cancer research infrastructure built up over the last 40 years is being eroded. Research that could contribute to new treatments and insights is lost. Clinical research and clinical trials are especially hard hit.

“Perhaps most worrisome of all, we are discouraging the next generation of investigators, especially physician scientists, from entering the field. I was one year out of training when I received my first major NCI grant. Now, we demand a junior faculty work until nearly the middle of his or her career before they can hope to get their first significant independent grant.

“The recent Ebola epidemic caught the international scientific community with its collective pants down because funding cuts, like you show here, prevented the work that would have averted the current crisis. These trends will mean the same for cancer.”

 

 

Stephen Gruber, director of the USC Norris Comprehensive Cancer Center, professor of medicine at the Keck School of Medicine of the University of Southern California, and the H. Leslie Hoffman and Elaine S. Hoffman Chair in Cancer Research at Keck Medicine of USC

“These data tell an important story over the last decade, but what we are reading is actually a compilation of a lot of short stories. The most recent short story has a really bad ending.

“Our investigators are continually applying for grants, and we are fortunate that we have been able to sustain success despite decreased paylines and budgets.

“I remain very concerned about the downward trends that are particularly evident since sequestration.”

 

 

Carlos Arteaga, president of the American Association for Cancer Research, professor of medicine and cancer biology, and associate director for clinical research at the Vanderbilt-Ingram Cancer Center of Vanderbilt University

“The charts that are included in this particular article are missing a key element, specifically that the budget numbers are not adjusted for inflation over the last ten years.

“By doing so, the charts would depict an even much more concerning and sobering picture because of the additional 22 percent decline in the budgets (when adjusting for inflation) that have occurred over the past decade for both NIH and NCI, as well as the institutions and cancer centers that are highlighted in the article.

“This important article underscores the importance of predictable and sustained budget increases for medical research, as this current long-term, significant reduction in funding for medical research is jeopardizing our ability to make critical advances against cancer and impeding long-term planning by the NCI and its parent agency, the NIH, as well as the scientists at the institutions and cancer centers that are supported by these two vital funding organizations.”

“In fact, this is a time for our nation’s policymakers to be prioritizing investments in medical research, as opposed to overseeing medical research budgets that are continually falling behind, which is resulting in missed scientific opportunities that ultimately may benefit patients.

“In light of this discouraging funding environment, it’s also important to consider the fact that cancer is a growing health care challenge: 585,720 U.S. residents are projected to die from some form of cancer in 2014, and this number is predicted to steadily increase in the coming decades without new preventive interventions and treatments.”

“As the founding organizer for the past three Rally for Medical Research-related events, including the most recent Rally for Medical Research Hill Day on Sept. 18, the AACR is significantly focused on making a difference in the overall NIH and NCI funding situation.

“Therefore, we were just overjoyed with the enthusiastic response and participation from the 300 organizations that are joining together to call on our nation’s policymakers to make funding for the NIH a national priority and raise awareness about the importance of continued investment in medical research.”

 

 

Nancy Davidson, director of the University of Pittsburgh Cancer Institute and UPMC Cancer Center, associate vice chancellor for cancer research, Hillman Professor of Oncology, and Distinguished Professor of Medicine and Pharmacology and Chemical Biology at the University of Pittsburgh

“We think these statistics confirm the work that we’ve put in over the last several years to really grow our research at the university and also specifically at the cancer institute, and this reflects the amazing recruitment that we’ve done and the growth in our research, especially our clinical and translational research.

“A really important point is, we at the University of Pittsburgh are getting a bigger fraction of the pie, if you will—but there is a question that the pie is not big enough for anybody.

“The real cost of research has gone up considerably, and the fact that the NIH budget has definitely not kept up with it, and not only has it not kept up with it, but we have seen a substantial loss because of biomedical inflation. You know, we are 20 percent down from what we would be if we didn’t have that inflation. I agree with you that there is a big mismatch between what we need, and where it can make a bigger difference in cancer, and what we are being provided. And that is true for our cancer institute, and every other cancer institute.”

“For our cancer institute, we think that this data reflects what we have been trying to do, which has been to grow our cancer enterprise, to be more competitive, to do what we need to do to garner the resources to try to do the best possible research, and ultimately to try and provide the best possible cancer care. So, for use, this reflects our reality: we have been growing and building for the last ten years and our funding reflects that.”

“So, good news from our perspective. We are a matrix cancer center and we’re excited that our funding is going up because it reflects our hard work, and the excellence of our faculty.”

 

 

William Nelson, director of the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center

“Overall cancer death rates throughout the nation are trending downward thanks in large part to state and federal programs aimed at research, screening and treatment.

“Cancer medicine is transforming from a model of treating disease only when patients experience multiple symptoms and often have widespread disease to one that detects, manages, and many times eradicates cancers well before their deadly stage.

“This change is being driven by pioneering discoveries in cancer genetics and epigenetics, funded largely by federal sources. We have the opportunity to build on our scientific successes and improve the way we preserve health by preventing cancers, very accurately predicting who will get them, and personalizing treatments to each individual patient, making sure he or she gets the treatments that will work against the unique cellular characteristics of the cancer.

“Our ability to continue these successful trends is tied directly to philanthropic, industry and federal funding of cancer research.

“From FY07 to FY13, our cancer center’s government funding decreased 17.6 percent while industry funding increased 142.4 percent and foundation/other funding is up 82.6 percent. Our overall funding is up 15.3 percent over that period, but down 4.6 percent from our peak in FY10.

“Many cancer centers’ funding has been reduced or flattened to levels not seen in more than a decade, due in part to an absolute 5 percent cut in funding to the NIH because of sequestration. Many research institutions experienced sequestration-related cuts double that amount.

“Cancer research funding is limited and very competitive. The federal commitment to cancer research is not adequate enough to keep up with scientific opportunity. We are fortunate at the Johns Hopkins Kimmel Cancer Center to have talented faculty who compete well among federal research grants. However, limited funding that is affected by economic and governmental changes discourages investigators from pursuing novel and challenging ideas.

“Funding cancer and other types of biomedical research goes far beyond our potential to eradicate disease. Many of our cancer centers and research institutions are leading employers in our states. We help young scientists establish careers and compete for larger, national grants.

“These funded investigators hire technicians, administrative and clerical staff. They purchase equipment and service from local and national businesses, invent new products, and start new companies. Moreover, the jobs created are ones that spark opportunity, are secure, and provide health insurance, education, and retirement benefits.

“The return on investment, in the form of salaries from job creation and tax revenue, far exceeds the nation’s original investment.

“We hope the current trends in federal funding of cancer research are reversed. Congress should complete the FY2015 appropriations bills and, at a minimum, restore funds lost to sequestration. We have millions of cancer patients and survivors depending on it.”

 

 

Steven Patierno, deputy director of the Duke Cancer Institute and professor of medicine, pharmacology and cancer biology at Duke University School of Medicine

“On the surface, these data suggest that most large, research-intensive cancer centers, whether freestanding or matrix centers, have either lost some fraction of their NCI funding, or remained relatively stable since 2003.

“The most disturbing trend evident from these data is the consistent decrease in NCI funding since 2011 at nearly all cancer centers.

“What is not evident from these data is the dramatic loss in purchasing power of each awarded research grant since 2003, which compromises scientific productivity of each grant period.

“The marked increased difficulty in obtaining individual investigator grants is resulting in increased attrition of experienced investigators, fewer first-time investigators, and potential loss of the next generation of cancer researchers.

 

 

Thomas Sellers, director of the H. Lee Moffitt Cancer Center, and Brian Springer, vice president of research administration

“These data underscore the reality that cancer funding, adjusted for inflation, is the same today as it was a decade ago. We are losing ground at a time when the opportunities for progress are greater than ever, and this weakens our ability to bring scientific findings to patient care.

“We must increasingly utilize other non-traditional sources of funding to make up for this, which can further complicate our research and require more sophisticated models for intellectual property and conflict-of-interest.

“Free-standing cancer centers can be more susceptible than matrix centers to funding swings, because of a (usually) more limited number of faculty, and less opportunity to spread revenues and indirect costs across a smaller, focused line of business. The end of ARRA funding affected all cancer centers.

“Since the support from the government doesn’t seem to be changing soon, all of us are being forced to explore alternative sources of revenue to secure the funds that are critical to the prevention and cure of cancer, requiring more sophisticated models for intellectual property and conflict-of-interest.”

 

  

Randy Main, vice president and chief financial officer of Fred Hutchinson Cancer Center

“NIH funding has played a central role in our major discoveries at Fred Hutch, including bone marrow transplantation, immunotherapy, radiolabeled antibodies, and the Women’s Health Initiative’s pivotal progress against breast cancer. These investments are proven investments in health and quality of life.

“The Annals of Internal Medicine published findings in May 2014 showing the $260 million NIH trial cost as having a net economic return of $37.1 billion dollars. All are high-impact discoveries that continue to save lives, discoveries that never would have happened without NIH funding.

“But decreased NIH funding has a serious, wide-ranging impact on our nation’s health and our capacity for medical innovation in the 21st century.

“At Fred Hutch, which ranks among the very top NIH-funded independent research institutions, the continued decrease in NIH funding translates into millions of dollars that are being lost for vital research projects. The greatest loss however, is lost opportunity at a time when we have the technology and knowledge to make advances in immunotherapy, precision oncology, and understanding the relationship between infectious disease and cancer.”

“We maintain our concern over NIH funding, but in the interest of accuracy, the majority of that drop [in 2013 NIH funding for Fred Hutch] resulted from a timing issue of a particular grant award that was corrected in the subsequent year. It does not reflect a permanent reduction in the grant funding. Those are based on awards and there was a timing difference that created a temporary drop that was corrected in the subsequent year.”

 

 

 

Steven Rosen, provost and chief scientific officer of City of Hope

“The key ingredient and the reason that City of Hope has been successful—and we anticipate will be more successful going forward—is because it’s mission driven, which is obviously very important.

“It is a modest institution in comparison to some larger medical centers: we have about 100 laboratory-based scientists. In general, they are very productive and a significant majority of them are cancer-focused.

“At the present time, we are blessed with significant revenues from philanthropy and royalties that are allowing us to expand the research base that we’ll have on campus, and recruit additional investigators. And so I think we have a very bright future ahead of us.

“Most of our research is NCI-directed. The state of our funding is positive, considering the environment, and it’s allowed us to maintain incredible stability.

“The philanthropy and royalties has created a sound foundation and we’ll be able to expand the number of investigators being recruited and attract top talent. I’m anticipating that the next decade will actually be even more productive.

“We’re one of few places that have the resources to expand dramatically.”

 

 

Kent Osborne, director of the Dan L. Duncan Center at Baylor College of Medicine

“NIH funding for cancer research has gone down significantly over the past decade, and this is certainly affecting our ability to advance some of the most exciting discoveries to improve outcome of patients as quickly as possible.”

 

 

 

 

Aman Buzdar, vice president of clinical research at the University of Texas MD Anderson Cancer Center

“The flat NCI budget is not very conducive for researchers to carry out innovative research—it is causing challenges for investigators trying to discover potential treatments that could be tested subsequently.

“I think resources have been constrained for the past few years. It is kind of disheartening for investigators everywhere, including institutions like MD Anderson.

“It affects all of us the same way. MD Anderson doesn’t have any special privileges—we are measured against the same yardstick like everyone else. All the investigators do.

“NCI funding has also not increased because of inflation. If you look at it realistically, even at the lowest inflation rates, it is just staying flat. You are losing 1 or 2 or 3 percent, depending on how much the inflation is each year. Essentially, if you look at it realistically, we are losing the resources that are available to the institutions and investigators each year by the increasing degree of inflation.

“If the NCI budget continues to remain flat, it means we are losing ground.”

 

 

Richard Schilsky, chief medical officer of the American Society for Clinical Oncology

“Federal funding for cancer research has steadily eroded over the past decade and threatens to stall the major progress that has been achieved in recent years.

“NCI plays a vital role in all federally funded cancer research and supports research projects conducted by universities and cancer centers across the United States and in other countries.

“These institutions provide the intellectual core of our nation’s research efforts to better understand cancer and to transform that understanding into better treatments for people with cancer.

“To ensure these institutions have the means to support high-quality cancer research projects requires that the federal government take bold action to improve funding for the core infrastructure and innovative research conducted at our nation’s cancer centers and universities. 

“ASCO will continue to call on Congress to provide a sustained investment in federal research and ensure our current pace of progress continues to accelerate.”

 

 

Howard Garrison, deputy executive director for policy and director of public affairs at the Federation of American Societies for Experimental Biology

“While there are some annual fluctuations, particularly at the smaller institutions, the most striking pattern is the overall lack of growth. When these budgets are adjusted for rising costs, they reflect a cut nearly 25 percent. This is part of an unprecedented reduction in research capacity that will haunt us for years.”

 

 

Mary Woolley, president and CEO of Research!America

“While research has helped reduce new cancer cases and annual cancer deaths over the last decade, more than 1.6 million Americans are newly diagnosed and we lose nearly 600,000 Americans to cancer each year.

“Those numbers alone call for a greater commitment to research, but here are more: The most recent estimates by the National Cancer Institute place the annual cost of cancer at $216.6 billion. Annual funding for the National Cancer Institute has hovered at about $4.9 billion over the last several years.

“So we’re spending hundreds of billions on care and productivity losses each year, and a few billion a year to wrestle those costs down. That disconnect is emblematic of the broader issue: the power of research to save lives and tax dollars justifies far higher levels of investment than our nation is making.

“It’s a strategic error, and now is the time to correct it. The downward trajectory of research funding is a sad state of affairs particularly for patients struggling to beat the odds and improve their quality of life.”

 

 

Carrie Wolinetz, president of United for Medical Research and deputy vice president for federal relations at the Association of American Universities

“Generally speaking, I see a fair amount of steady support over time. Obviously, if you adjust for biomedical inflation, that steady support ends up being a downturn. But the steady state indicates a couple of things:

“One, continued interest in solving the incredibly complex problem that is cancer and its many different diseases. Given that the data starts at the tail end of the doubling of the NIH budget, the fact that interest hasn’t declined since the doubling is good news.

“Two, the support also probably speaks very well to the exciting state of science. In the last decade, competition has gotten so fierce in the research community in general. The fact that we’re seeing steady, and in some institutions, an uptick, really speaks to where we are in science.

“If you’re looking at the steady state of funding, it doesn’t seem to be—I hate to say falling off in popularity—a reduced portion of the NIH portfolio, for sure.

“As I keep factoring in inflation, the figures are showing a lack of growth—somewhat reflective of the overall lack of agency growth, but also not a sharp decline either.”

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