publication date: Mar. 16, 2018

Conversation with The Cancer Letter

Porter: I can’t tell you how the Trump administration gets its budget numbers

john-edward-porter

John Edward Porter

Former House appropriator who oversaw the doubling of the NIH budget

 

John Edward Porter, a long-time key Congressional appropriator and advocate for biomedical research, received the Research!America Legacy Award at an advocacy awards dinner March 14.

At the event, Research!America announced that the Legacy Award will be named in his honor—the John Edward Porter Legacy Award.

Porter was U.S. Congressman from the 10th district in Illinois for 21 years, serving on the U.S. House Committee on Appropriations and chairing the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.

 

Porter spoke with Paul Goldberg, editor and publisher of The Cancer Letter.

 

Paul Goldberg:

The administration tried to slash the NIH budget by about 20% a year ago and failed. Then they regrouped and tried to slash it by 27% this year. What are they trying to accomplish? What’s the message they are sending?

John Porter:

They are sending a message to their base that they’re into cutting down on government.

 

PG:

They don’t care about the fact that it’s life-saving research?

JP:

No.

 

PG:

They just don’t care?

JP: 

No. They are cutting all kinds of programs that are important to people. They just want to show that they’re working to cut the size of government, and also the deficit.

 

PG:

Well, Congress has rescued NIH twice now. How long can this go on, this attack-and-rescue cycle?

JP:

Remember, the President’s budget has no force or effect. It is merely the President’s suggestion as to which way he would like to see things go. Congress has the legislative power. And Congress sometimes pays very close attention to a President’s budget, and other times they ignore it completely.

 

PG:

Well, this is certainly a time when they are ignoring it completely.

JP:

Yes, and they control both houses of Congress.

 

PG:

Right. But do you fear that ultimately they might prevail?

JP:

No.

 

PG:

Just no chance?

JP:

No.

 

PG:

Congress is too sober?

JP:

No. Congress has a lot of supporters for medical research, including a lot of Republicans. The Republican chairs of the Labor, HHS Subcommittee in both the House and the Senate are strong supporters of medical research and NIH. I feel quite sanguine about the end result being a strong one for continuing increases for NIH. A lot depends upon the allocations.

 

PG:

Which are working in favor of NIH at this point.

JP:

Well, the allocations to the subcommittee are what they have to work with. We just don’t know how those are going to turn out.

 

PG:

What struck me as disturbing in the budget proposal was the lack of justification for the cut that was being proposed. This wasn’t really punishment. It just represented the level of spending that the administration considers appropriate. Can this be allowed to just stand without being confronted.

JP:

Well, we’ll confront it. You’ve got to remember that they’re not only cutting NIH; they’re cutting all kinds of support safety net programs that are in the Labor, HHS bill, for example. They would like to see them cut also.

 

PG:

But still, there should be just a very clear statement that this just won’t do. Because it might come back. Shouldn’t this be taken seriously?

JP:

Absolutely. Absolutely, it should be taken seriously. Research!America hopes every day to send a message to members of Congress, either directly or through their supporters or people back home, that this spending cannot be allowed to drop it, and in fact it should be increased.

 

PG:

How do they even get these numbers? 20%, 27%. Do they do astrology or …

JP:

With this administration, probably.

 

PG:

Got it.

JP:

I can’t tell you how they get their numbers. They look at the overall spending rate, and then they determine where they’re going to suggest cuts and the hopeful message is to the people who want to cut down on the size of government and its reach, that they are doing what they were elected to do.

 

PG:

What does a 27% cut do? Can you even imagine such a thing?

JP:

Oh God. It would devastate medical research. Definitely devastate it.

 

PG:

What would it do?

JP:

I don’t know the numbers that I suppose you have, but what are we at—$32 point something billion overall?

Take better than a quarter of that away. You are down to $24 billion, or $23 billion? When we doubled funding for NIH, when I was subcommittee chairman, and funded NIH, we were working were from a base of $13.5 billion and got it to $27 billion. So, $24 [Trump’s proposal] would be below that number. It would be a devastating cut. It would take us back to the Dark Ages.

 

PG:

When you were in charge of appropriations, one way to make you irritated was to try to use the appropriations process, in place of the Legislative process. I see this game is very much being played now, like with Planned Parenthood for example. Is there a way to make this stop?

JP:

The way it works in the House at least, if you’re going to try to put a legislative provision into an appropriations bill you’ve got to get the signoff of the authorizers who would have had jurisdiction. They would have to say, “Oh yeah, that’s something we would have done but you go ahead and do it in the appropriations bill.” I think that’s always problematic to whether that’s going to happen. But if they do sign off, then it does happen.

 

PG:

Now that NIH has some real money, should the argument for growing NIH change now? It’s really quite a target for other constituencies. What should advocates for NIH do differently?

JP:

Than they’ve been doing?

 

PG:

Yeah.

JP:

Nothing.

 

PG:

It’s all good?

JP:

As I said, we work every day with the appropriators on trying to ensure there’s a substantial increase for NIH and for other programs, like CDC and AHRQ, and I think we should continue to do that. It’s been successful.

 

PG:

It’s good strategy?

JP:

Yeah. You just have to keep working on it. And we have gotten the Republican chairmen in both the House and the Senate aboard of those kinds of increases.

 

PG:

What’s your guess how long it should go at about $2 billion a year clip for NIH?

JP:

It depends on the economy. It depends on the revenue that the government receives. You’ve got have the money in order to spend the money, so revenue is very important.

 

PG:

So there’s no hard ceiling? The doubling was a doubling. This is not a doubling, this is kind of in perpetuity, sustainable and measured.

JP:

The idea after the doubling was to go back to the historic rate of increase of NIH, at least, which was 3% real [above biomedical research inflation rate] per year. That ended, if you look back in the United States since about 1945, 47, 48 right in there, that every year was about the average rate of increase.

Let’s say it’s $36. One billion would satisfy 3% or so. Getting two was like gravy. You always work for the highest level we can get.

 

PG:

Is there anything we have missed? Any other points you’d like to make?

JP:

I think what’s happening out there in the election process is extremely important, and I think the people who support NIH should be out there going to the town hall meetings, going to the campaign meetings, and asking the questions. Do you support NIH funding and how strongly?

Put them on the spot. That seems to be extremely important. People who will support NIH and determine who the candidates that support NIH.

They have to make sure they get the polls and their friends get to the polls and their colleagues get to the polls, because being for something means nothing in an election unless you actually vote.

My message to anybody is get out there and participate in democracy, where everybody gets a chance to have input, and every vote counts.

I’ve been looking at the 18th Congressional District in Pennsylvania today, to see which candidate there is more likely to be supporting medical research, and I would say Conor Lamb, the Democrat, is much more likely than [Rick] Saccone, a Trump guy all the way, would be supporting the increase in funding.

That’s the kind of thing that the people have to figure out and then get to the polls and vote that way.

 

PG:

It’s a question you totally don’t need to answer if you don’t want to … are you still a Republican?

JP:

Am I still a Republican?

 

PG:

Yeah.

JP:

Well, let me put it this way. I never left the Republican Party. The Republican Party left me.

 

PG:

Thank you for answering the question.

JP:

If I was there, I wouldn’t be voting with the Trumpistas. Believe me.

 

PG:

Absolutely. It’s a scary time.

JP:

Yeah. Extremely scary time.

 

In addition to Porter’s Legacy awards, the following awards were presented:

Sen. Susan Collins (R-ME) received the Edwin C. Whitehead Award for Medical Research Advocacy. Collins is the chairman of the Senate Aging Committee and the founder and co-chair of the Senate Alzheimer’s Task Force. She is also the founder and co-chair of both the Senate Alzheimer’s Task Force and Senate Diabetes Caucus. Since the diabetes caucus was founded, funding for diabetes research has more than tripled from $319 million to more than $1 billion in 2017. 

Atul Gawande, surgeon, writer, and public health researcher and advocate, received the Isadore Rosenfeld Award for Impact on Public Opinion. Gawande practices general and endocrine surgery at Brigham and Women’s Hospital, and is a staff writer for The New Yorker magazine, publishing essays on the science and practice of medicine, from people’s individual experiences to the effects of national policy. He is professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. He is also Executive Director of Ariadne Labs, a joint center for health systems innovation through simple, scalable solutions that improve the delivery of care. Gawande is chairman of the non-profit organization Lifebox, which is bringing the Safe Surgery Checklist, shown to cut post-operative deaths in half, to low-income countries around the world.

Roger Glass, director of the Fogarty International Center and associate director for international research at the NIH, won the Geoffrey Beene Builders of Science Award. Glass oversees an extensive portfolio of grants and awards that support training of global health researchers and facilitates NIH’s research and training partnerships abroad. Glass’s research expertise is in the prevention of gastroenteritis from rotaviruses, noroviruses and cholera. He has maintained field studies in India, Bangladesh, Brazil, Mexico, Israel, Russia, Vietnam, China and elsewhere, and created a team of epidemiologists and virologists that spearheaded global efforts to research and introduce rotavirus vaccine worldwide.

Shari and Garen Staglin, founders of the Staglin Family Vineyard, received the Gordon and Llura Gund Leadership Award for their commitment to accelerating cures for brain disorders through scientific research. Their focus on brain health research is the result of their son Brandon’s diagnosis of schizophrenia in 1990. Brandon is now director of marketing and communications at One Mind Institute and his sister Shannon is president at the Staglin Family Vineyard. The Staglins founded One Mind, One Mind Institute and Bring Change2Mind to address brain disorders and stigma. For the last 23 years their annual Music Festival for Brain Health, along with their other advocacy efforts, have raised over $280 million for brain health research. 

The EveryLife Foundation for Rare Diseases has been selected to receive the Paul G. Rogers Distinguished Organization Advocacy Award. The EveryLife Foundation was founded in 2009 to improve the regulatory process for drug development, from clinical trials to approval, by working with patient organizations, industry, academic scientists, FDA, and NIH to spur insightful scientific analysis and dialogue, expand grassroots support, and ultimately bring about key policy changes.

Peter Hotez, received the Research!America Advocacy Award for Sustained National Leadership for his far-reaching work in the areas of neglected tropical disease research and vaccine development. Hotez is dean of the National School of Tropical Medicine at Baylor College of Medicine where he is also professor of pediatrics and molecular virology and microbiology. He serves as the director of the Texas Children’s Hospital Center for Vaccine Development, where he leads a product development partnership for developing new vaccines for hookworm infection, schistosomiasis, Chagas disease, leishmaniasis, and SARS/MERS, diseases that affect hundreds of millions of people worldwide. In 2006 at the Clinton Global Initiative, he co-founded a Global Network for NTDs to provide access to essential medicines for hundreds of millions of people. Hotez was among the first to predict Zika’s emergence in the U.S. and is recognized as an authority on vaccines.

Copyright (c) 2018 The Cancer Letter Inc.