It would be fair to say that Patient 5 owes his life to medical research. Also known as David Aponte, he was the headlining success story from a recent clinical trial at Memorial Sloan-Kettering Cancer Center. The trial tested a new approach — in which a portion of the immune system is genetically altered and then reintroduced to the body — for treating an otherwise fatal leukemia.
But when we celebrate the remarkable achievement made possible by the doctors behind the experimental treatment and the patients who volunteered themselves for research, there are two other guests of honor to include at the party: years and years of basic science, and the public dollars that funded them. Sadly, those guests are finding it increasingly tough to get invitations.
For the last several years, the federal budget for the National Institutes of Health, the world’s largest source of basic research funding, has remained at $30 billion a year. If inflation is factored into the numbers, funding has decreased since 2002. The 2012 NIH budget was $30.7 billion, a $299 million increase over 2011 levels, but accounting for only about 1.25 percent of all tax revenue collected in 2012. The sequestration enacted March 1 cut the NIH budget 5.1 percent, a loss of $1.6 billion annually.
The NIH funds scientific research through a variety of research grants. Ranging from about $100,000 to millions of dollars, these awards support research into cancer, Alzheimer’s disease, depression, obesity, stem cells, genomics, hepatitis, nutrition — every facet of human health and illness.
The oldest type of NIH grant, known as R01, covers the largest number of researchers. These grants provide years of coverage for salary, supplies, publication fees, administrative support and other costs essential to laboratory research. In 2002, 24.5 percent of R01 applications were funded. By 2012, the approval rate had dropped to 14.9 percent. Such decreases exist across the range of NIH grants and are exacerbated by the sequestration measures, which will result in about 700 fewer research grants in 2013 than in 2012, according to an analysis by Sen. Tom Harkin, D-Iowa, a sponsor of the Budget Control Act.
Already, young investigators find it harder to get funded than older academics deep into a specific pursuit. With funds increasingly difficult to come by, young investigators are more likely to leave academia, leave the U.S. or leave science entirely. And with 70 percent of NIH grant money going toward salaries, less funding means fewer young researchers will be hired to work at the large, well-equipped laboratories of more senior grantees.
The cell therapy that saved Aponte’s life is hardly the first example of basic research leading to an unexpected leap in medical care. It took 30 years for the causative connection to be made between the genetic mutation known as the Philadelphia chromosome and chronic myeloid leukemia. But establishing that link led to the creation of Gleevec, the first drug that targets cancer at its root cause, a breakthrough that transformed the future of cancer research and drug development.
Examples abound of breakthroughs that grew out of long, costly scientific inquiry. Studies of the microscopic structure inside corals eventually led to the creation of an implant that promotes tissue growth after bone grafts. The Human Genome Project was funded by about $2.7 billion in taxpayer dollars. Even the skin-smoothing bacterial toxin known as Botox is the result of taxpayer-supported science. T
the fact remains that public support for basic science is inherent to medical progress. “If you do good basic research, then who knows what’s going to happen down the way?” Herb Abelson once told me. A pediatric oncologist, he made laboratory investigations of a leukemia-causing virus in the 1960s that were unexpectedly vital to the eventual creation of Gleevec. Without adequate support, good research becomes increasingly impossible.