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Emily Cribas
CAS 138T
April 25, 2014
Public Funding for the National Institute of Health
The Importance of Biomedical Research
What makes a society successful? Economic growth? National security? Political
freedom? All of these are true, but at the base of all these qualities is public health. Public
health is one of the most significant factors for assessing societal success.
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Economic prosperity cannot be achieved by an ailing nation; it is contradictory to
defend our nation from foreign attack, when we cant defend our own immune systems;
political freedom is out of the question when the country is facing a bigger problem: high
mortality rates. Needless to say, without a proper foundation for public health, any nation
is doomed to fail.
Health Benefits
At the core of public health is biomedical research. This type of research deals
with experimental techniques that can be applied in hospitals and clinics. Their ultimate
goal is to develop effective treatments and cures to illness and disease. This area of
research has had breakthrough discoveries such as the discovery of penicillin, the
sequencing of the human genome project, and the creation of artificial organs. In
America alone biomedical research has decreased heart disease-related deaths by a total
of 65 percent in the last 60 years. It has reduced cancer mortality by 12 percent and
deaths from strokes by 34 percent.
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One of the biggest biomedical research institutes today is the National Institute of
Health (NIH.) It distributes about 30.1 billion government-funded dollars annually to
more than 300,000 researchers at more than 2,500 universities, medical schools, and
other research institutions through grants.
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In its totality, the research the NIH helps fund
has added a year to every six years of each Americans lifespan.
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Economic Benefits
Besides the obvious health benefits of biomedical research, it is also important for
economic growth. Through awarding research grants and scholarships to thousands of
laboratories across the nation, the NIH has helped create 430,000 quality jobs that
produced more than $62 billion in new economic activity in the year 2011 alone.
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In other
words, for every dollar invested in this research, $2.21 is generated in economic output.
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Some projects by institutes and universities have generated even more economic activity.

The Human Genome Project (part of the National Human Genome Research
Institute) is a clear example of the benefits publicly funded biomedical research projects
can have on the economy. The government spent about $3.8 billion to fund the program,
but its returns were a whopping $796 billion.
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This project can now help detect
predispositions to disease, use genetic information to personalize medicine, and diagnose
rare illnesses.
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In the process, it also created a new field of medicine: personalized
medicine. This new field will also help create new jobs and new research projects that
need paid scientists.
More examples of economically successful NIH projects are those conducted at
the University of California-San Francisco. UCSF is constantly ranked in the top 5 public
recipients of NIH grants, receiving billions of dollars for their program.
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Its health-
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science areas of research have been valued at $1.1 billion because of the caliber of their
research, and grants from the NIH, have allowed USCF to generate over $6.2 billion in
economic benefit to the economy by creating jobs, companies, products, and providing
direct healthcare to the San Francisco Bay area and beyond.
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Identifying the Problem
Even with the obvious benefits that come from publicly funding biomedical
research, the government is not funding enough for the NIH.
The Causes
The effects of flat funding, inflation, and sequestration have had severe
consequences on NIH research. This, in turn, has a domino effect on every research
institute and university that receives funding from the NIH.
But if the government spends about $30 billion annually on NIH funding, then
what is the problem? The reality is that this amount is not keeping up with the inflation
the country is experiencing. As can be seen in Figure 1, the value of the money being
funded for the National Institute for Mental Health, an asset of the NIH, has been
diminishing each year in real dollars, as a result of flat funding for the past decade.
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Figure 1. NIMH Funding in Real 1998 Dollars

Additionally, the sequestration that was set to occur in 2014 by the 2011 budget
control, caused by the governments lack to reach consensus on how to reduce the deficit,
forced the government to reset limits on discretionary spending in 2014.
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Implications
Presently, the decrease in NIH funding due to flat funding has led to lower and lower
grant application success rates as seen in Figure 2.
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Basically, not enough grants can be
given if not enough funds are provided. Overall, this means that more potentially life-
saving research projects are being rejected each year.





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Figure 2. NIH Grant Application Success Rates

The sequestration led to a $1.7 billion dollar loss to the NIH, as well as 750
fewer patients being admitted into the NIH Clinical Center and 700 fewer competitive
research grants being issued in FY 2013 than in FY 2012.
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This loss of funding affects university research. Many universities such as John
Hopkins, the University of Pennsylvania, UCSF, and UCLA receive about 80 percent of
funding for research from government agencies, NIH being one of the main
contributors.
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A decrease in NIH funding leads to a decrease in funding for biomedical
research at these schools, which wont be able to receive the same amount of funding
needed for their programs.
Dr. David Eisenberg, biochemistry and molecular biology professor at UCLA,
states that without help from agencies such as the NIH and NSF, UCLA would have no
scientific equipment in their labs. The lack of proper equipment and technology would be
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detrimental not only to undergraduate researchers, but also to professors who conduct
research, who would see their salaries cut and risk losing their jobs.
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Future lack of adequate funding for the NIH can also be detrimental to the future
economy and can cost the United States billions of dollars. Specifically, with fewer
neuroscience research projects being passed, we are not effectively dealing with
psychiatric and neurological illnesses that cost the economy more the $460 billion.
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By
not funding more of these projects, we are also not giving as much priority on mental
disorders that cost the economy $300 billion.
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These effects would be felt in full effect in
the future.
From an international perspective, the United States has decreased its spending of
global biomedical research expenditures from 51 percent in 2007 to 45 percent in 2012.
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At the same time, Japan and China increased their spending by $9 billion and $6.4
billion, respectively.
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While America is decreasing its funding for biomedical research,
leading to a decrease in total R&D spending, countries such as China are increasing their
total spending at an alarmingly fast rate, as shown in Figure 3.
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Figure 3. Scientific R&D Spending in the US

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At this pace, China, and possibly Japan, will soon displace the United States as
global leaders of scientific innovation. While these countries increase their spending on
biomedical research as well, the total effect of their economic success will also be felt in
the near future, because their increased spending will result in long-term benefits, such as
job creation.
Also, with decreased funding, the process of treating and curing diseases will be
slowed in the US. Meanwhile, China and Japan will most likely develop the technology
from their increased funds to understand diseases better, and find cures before the United
States can. They will have medicine and treatment available before the United States
does, and the US will most likely have to buy these treatments from them, an unnecessary
economic cost.

Course of Action
The most obvious answer would be to increase NIH funding. The question is:
how? The government must effectively fund the NIH to optimize success rates of
projects.
Recently, President Obama has currently implemented the BRAIN initiative, run
under the NIH, which hopes to accelerate the development and application of innovative
technologies, to better understand the human brain. He hopes to double its funding to
$200 million in FY 2015.
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This research initiative will focus on the neurological
disorders that are costing citizens billions of dollars, and can potentially save us billions
if passed by congress.

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Additional possible courses of action include:
A change in mentality. For the United States to be united in this cause, citizens and the
government must both look past how much the funding may cost, and see the thousands
of jobs and research projects that will be created as a result, generating economic activity
that is twice, on average, the initial cost. Funding biomedical research is a long-term
investment that, in the future, will save the US billions. For example, more neuroscience
research (i.e. more grants available for neuroscience research) could potentially delay the
onset of Alzheimers by five years, which could save the US $51 billion dollars in health
care by 2015.
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Use cost-benefit analysis. Assess the efficiency of each NIH sector, and conduct a cost-
benefit analysis. NIH grants and funds go to hundreds of research projects. If these
projects have tangible benefits to society that overcome the initial costs after a certain
number of years, then the project should be maintained. If not, funds should be
reallocated elsewhere.
Since the NIH also focuses on public relations, this sector should also be assessed.
These events include outreach events to the community that help regular citizens
understand and become informed about biomedical research and disease. To assess the
efficiency (cost-benefit) of these programs, the government could offer incentives for the
NIH to make participants fill our surveys about their experience, and how it could be
improved, similar to teaching evaluations conducted at universities. By constructively
criticizing the institute, it can become more efficient in their funding.
After the overall efficiency of each sector of the NIH is analyzed, those with the
most potential to save lives and generate the most economic activity should receive more
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funding, and those who do not, should be questioned on their research and forewarned
before being cut.
Set a permanent standard. In case of economic instability, such as a sequester or
increased inflation, funding for the NIH should be set prior to everything, and should be
left untouched. The amount that should be set should also match up with the inflation
levels to ensure that funding is remaining the same, or preferably increasing. Along with
this, it would be helpful to set a permanent increase in funding, with an end goal of
possibly doubling the budget for NIH funding with the next decade.
Provide incentives. Provide small incentives to companies who could benefit from
funding the NIH. In this way, less federal money is used, and companies are investing
more to make a profit, generating economic activity.

Complications
With billions of dollars invested into thousands of labs, it can be difficult to
conduct an in-depth analysis of each lab to calculate its efficiency. The same can be
applied to outreach programs. With so many participants and so many locations
nationwide, it can be difficult to keep track of the cost-benefit of each institute, each lab,
and each program.
As for setting a permanent standard, it may be difficult to set an appropriate
amount of money for something, because things always change. For example, if the US
goes to war, more money has to be invested towards defense. If a natural disaster strikes,
more money has to be invested towards FEMA.
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Finally, providing incentives to companies can backfire if the results do not show
up fast enough for companies to consider their investment a success. By encouraging
private funding through public incentives, there is no way that can replace the 40 percent
of biomedical research funds that come from the government, but we can come close.
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Opposition
The government may oppose the idea of increasing funding for the NIH on the
belief that that research agencies could fund more research, with the same amount, if they
were smarter about investing it. In this case, some members of Congress think that too
much of the NIHs public funding goes towards public relations (PR), such as outreach
events, and therefore, government should not increase overall NIH funding to waste
money on PR. This is true, seeing how the NIH spent $181.3 million on public relations
in 2012.
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However, these public relations expenditures are highly valuable to the
community. By reducing spending in this area, there would be virtually no relief to fund
researchas a result of sequestration, a decade of flat funding, and inflation.
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The
amount of money spent on public relations is necessary as it provides a more interactive
and healthy relationship between the scientific community and the citizens, making sure
important medical ideas and problems are communicated effectively to the public.

Concluding Remarks
If the inadequate lack of funding for the NIH is not addressed as soon as possible,
the United States runs the risk of wasting time that could be spent saving lives, losing an
amazing opportunity to improve the economy, and losing its status as a pioneer in
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biomedical research. For these reasons, action must be taken now by the government to
effectively deal with the situation.
If funding for the NIH is strategically increased based on cost-benefit analysis, the
US could save millions of more lives, prosper economically in the near future, and
solidify its standing as a global leader in scientific innovation.


















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Endnotes
1. Hall, Peter A.. Successful societies: how
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2. Frist, Bill. "Why America can never give up on
medical research." The Week. THE WEEK
publications, 25 Sept. 2012. Web. 25 Apr. 2014.
<http://theweek.com/article/index/233786/why-
america-can-never-give-up-on-medical-research>.
3. "NIH Budget - About NIH - National Institutes of
Health (NIH)." U.S National Library of Medicine.
U.S. National Library of Medicine, 11 Mar. 2014.
Web. 25 Apr. 2014.
<http://www.nih.gov/about/budget.htm>.
4. "Biennial Report of the Director." , National
Institutes of Health Fiscal Years 2010 & 2011 >
About NIH > Statement of the Director. N.p., 1
Jan. 2012. Web. 25 Apr. 2014.
<http://report.nih.gov/biennialreport/chapter1/1_N
IH_Director_Statement.html>.
5. "- DEPARTMENTS OF LABOR, HEALTH
AND HUMAN SERVICES, AND EDUCATION,
AND RELATED AGENCIES
APPROPRIATIONS FOR FISCAL YEAR 2013."
- DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR
FISCAL YEAR 2013. N.p., 28 Mar. 2012. Web. 25
Apr. 2014.
<http://www.gpo.gov/fdsys/pkg/CHRG-
112shrg29104500/html/CHRG-
112shrg29104500.htm>.
6. "Our Economy - Impact - About NIH - National
Institutes of Health (NIH)." U.S National Library
of Medicine. U.S. National Library of Medicine,
12 Mar. 2014. Web. 25 Apr. 2014.
<http://www.nih.gov/about/impact/economy.htm>
.
7. Gitlin, Jonathan Max. "Calculating the economic
impact of the Human Genome Project."
Calculating the economic impact of the Human
Genome Project. N.p., 12 June 2013. Web. 25
Apr. 2014.
<https://www.genome.gov/27544383>.
8. Ibid.
9. Bole, Kristen. "UCSF Schools Lead the Nation in
NIH Biomedical Research Funds." University of
California, San Francisco. N.p., 12 Feb. 2014.
Web. 25 Apr. 2014.
<https://www.ucsf.edu/news/2014/02/111791/ucsf
-schools-lead-nation-nih-biomedical-research-
founds>.
10. Ibid.
11. "2014 Winter Inside NIMH." NIMH RSS. N.p., 1
Jan. 2014. Web. 25 Apr. 2014.
<http://www.nimh.nih.gov/research-
priorities/inside-nimh/2014-winter-inside-
nimh.shtml>.
12. "The Sequester - What is it." The White House.
The White House, n.d. Web. 25 Apr. 2014.
<http://www.whitehouse.gov/issues/sequester>.
13. Rockey, Dr. Sally, and Dr. Francis Collins. "One
Nation in Support of Biomedical Research?." NIH
Directors Blog. N.p., 24 Sept. 2013. Web. 25 Apr.
2014.
<http://directorsblog.nih.gov/2013/09/24/one-
nation-in-support-of-biomedical-research/>.
14. Stein, Sam. "NIH Losing $1.7 Billion, 700
Research Grants Due To Sequestration." The
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Huffington Post. TheHuffingtonPost.com, 4 June
2013. Web. 25 Apr. 2014.
<http://www.huffingtonpost.com/2013/06/04/nih-
sequestration_n_3385949.html>.
15. Ehrlich, E. NIHs Role in Sustaining the U.S.
Economy. United for Medical Research. 2012.
16. Eisenberg, David. "Submission: Loss of
government funding hurts scientific research,
economy." Daily Bruin. N.p., 16 Oct. 2013. Web.
25 Apr. 2014.
<http://dailybruin.com/2013/10/16/submission-
loss-of-government-funding-hurts-scientific-
research-economy/>.
17. Brain Facts: A Primer on the Brain and Nervous
System. Society for Neuroscience. 2012.
18. CDC Report: Mental Illness Surveillance Among
Adults in the United States. Centers for Disease
Control and Prevention. September 2011.
19. Bidwell, Allie. "U.S. Medical Research Spending
Drops While Asia Makes Gains." US News.
U.S.News & World Report, 2 Jan. 2014. Web. 25
Apr. 2014.
<http://www.usnews.com/news/articles/2014/01/0
2/us-medical-research-spending-drops-while-asia-
makes-gains>.
20. Ibid.
21. Rockey, Dr. Sally, and Dr. Francis Collins. "One
Nation in Support of Biomedical Research?." NIH
Directors Blog. N.p., 24 Sept. 2013. Web. 25 Apr.
2014.
<http://directorsblog.nih.gov/2013/09/24/one-
nation-in-support-of-biomedical-research/>.
22. "President Obamas Proposal to Double Federal
Funding for the BRAIN Initiative." The BRAIN
Initiative SM. N.p., n.d. Web. 25 Apr. 2014.
<http://brainfeedback.nih.gov/president-obamas-
proposal-to-double-federal-funding-for-the-brain-
initiative/>.
23. Medical Research: Saving Lives, Reducing the
Cost of Health Care, Powering the Economy.
Research!America. 2012.
24. Salzberg, Steven. "Congress Is Killing Medical
Research." Forbes. Forbes Magazine, 14 Jan.
2013. Web. 25 Apr. 2014.
<http://www.forbes.com/sites/stevensalzberg/201
3/01/14/congress-is-killing-medical-research/>.
25. Pickett, Chris. "Scrutiny on spending at the
National Institutes of Health increasing." ASBMB
Policy Blotter. N.p., 17 Apr. 2013. Web. 25 Apr.
2014.
<http://asbmbpolicy.wordpress.com/2013/04/17/s
crutiny-on-spending-at-the-national-institutes-of-
health-increasing/>.
26. "Monthly Archives: June 2013." The Washington
Update. N.p., 1 June 2013. Web. 25 Apr. 2014.
<http://washingtonupdate.faseb.org/?m=201306&
paged=2>.

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