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The Fiscal Cliff Is Forcing a Biomedical Day of Reckoning

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the domain of more “applied” research organizations, like drug companies. But drug company R&D divisions have a tradition of being risk-averse, and more recently they have been suffocated by financially motivated megamergers that have made them almost too big to innovate. Many of them just aren’t set up to pick up these relatively raw research ideas and give them the oxygen they need.

To use a football analogy, basic researchers at universities take the kickoff at the 1-yard line, and the good ones can advance it as far as the 20-yard line. Pharma and biotech companies may have once been able or willing to take the ball there and advance the remaining 80 yards downfield, but not so much anymore. Their own scientific failures and financial pressures have forced them to focus mostly on taking over possession in the red zone, and then running the ball up the gut for the last 20 yards to score a touchdown—a new FDA-approved product. That leaves a whole lot of area in the middle of the field where nobody’s playing very much.

Somebody needs to figure out how to best get that work done in the middle, and keep the ball moving downfield. It’s hard, because there isn’t much professional glory there for the scientists, and not much financial reward for the businesspeople. Some encouraging experiments are being run at the moment, in which companies like Pfizer, Sanofi, Johnson & Johnson, and others are working hard to improve the way they interact with scientists on university campuses. Some academic institutions, like UC San Francisco, have shown willingness to engage in this creative rethinking of the biomedical R&D continuum.

While those efforts are encouraging, this really should be a national conversation that involves a whole lot more players.

Peter Kuhn, associate professor of cell biology at The Scripps Research Institute, pictured with Kelly Bethel

Peter Kuhn, an associate professor of cell biology at The Scripps Research Institute in San Diego, summed up this opportunity in a thoughtful email on Friday.

“The scientific enterprise of this nation is in the middle of one of the largest makeovers in its history. On the one hand we have at our fingertips ultra-advanced analytical tools that truly enable human investigation. We have biological insights and technological platforms that allow us to understand disease at the single patient level over the course of a disease. We are in the middle of making personalized medicine a reality—only one problem, ‘nobody can afford to care.’”

Actually, I care. And I think most people in the U.S. would care if they knew what was happening in biomedicine, and how little our nation spends on it compared with defense and entitlement programs.

What it boils down to is this: We have an amazing opportunity to advance healthcare through biomedical research in the coming decades. We don’t have unlimited money to pursue this goal, and it would probably be counterproductive to throw massive new money into the system anyway. So the question becomes: How to get the most bang out of the $31 billion or so that goes to the NIH each year? In the past, NIH review teams sought to weed out shoddy proposals and reward clear thinking that could advance a field. But in an era of financial constraint, as Kuhn puts it, the emphasis should be more about making sure the necessary science gets done.

“The difference between the two is tremendous and must be thought through very carefully. The value of science comes from its impact on our lives. Those who care need to be around the table to shape it,” Kuhn says.

I have to agree. Scientists can’t just sit in their science caves and whine about how there isn’t enough money to support all their ideas. There’s never going to be enough money. The plan should be to advance both the basic and applied research fronts, with a goal of producing benefits for human health. Scientists can choose to take action and be a part of crafting this future framework for research. Or, they can stand by and be acted upon by people who may or may not know that fruit flies are important. I hope it doesn’t come to that.

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One response to “The Fiscal Cliff Is Forcing a Biomedical Day of Reckoning”

  1. @ConsanoCMO says:

    Luke, you are quite correct — the current system for funding research needs improvement. In a time when research dollars are finite, and ideas for new projects are infinite, researchers should be encouraged to collaborate through sharing of data and ideas to better utilize each research dollar. The NIH tends to fund less risky projects, but many novel therapies can be discovered through less conventional means. It can be difficult to weed out the “less worthy” research projects from those that hold the most promise in advancing medical science, thus making the allocation of the NIH budget very challenging. Moreover, many disease categories are underfunded, such as pediatric cancers, which receive just 4% of the total NIH budget. As the Chief Medical Officer for Consano, a nonprofit crowd funding platform for medical research, we envision the public making their voice heard through their donation. At Consano.org, the public can browse a list of vetted medical research projects from a variety of academic institutions, decide which projects resonate with them, and donate directly to that specific project. While our platform may not compete on the same financial plane as the NIH budget, perhaps the public nature of Consano will encourage greater sharing of data and ideas, create new connections between donors and researchers, and place the focus of medical research funding directly on making patient care advances.