13 March 2008. Schizophrenia researchers and advocacy groups have resigned themselves to a further tightening of research funds in the wake of the $555 billion omnibus appropriations bill for Fiscal Year 2008 signed into law last December by President Bush.
“The budget this year brings more of the same bad news that the psychiatric research and neuroscience research communities have experienced over the course of most of this Administration’s tenure,” says Jeffrey Lieberman, chair of the American Psychiatric Association’s Council on Research.
The omnibus bill, which combined 11 unfinished appropriations bills to provide funding for the National Institutes of Health (NIH), the National Science Foundation (NSF), the Department of Veterans’ Affairs, and other agencies, was hastily assembled before the holiday recess when House legislators narrowly failed to override Bush’s November veto of the of the Labor, Health and Human Services, and Education appropriations bill, which included NIH funding.
In the face of the president’s threats to veto any further appropriations legislation that exceeded the $932 billion he had set as the upper limit for domestic spending, Democratic congressional leaders axed $22 billion in spending in the omnibus bill, abandoning the 3.7 percent increase for NIH they had requested previously.
In the end, after accounting for a transfer of $295 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the NIH saw an increase of only .46 percent. With the agency’s Biomedical Research and Development Price Index (BRDPI) —which attempts to calculate the inflation rate for goods and services purchased by the NIH budget—now pegged at 3.7 percent, this year’s NIH budget represents an effective cut of 3 percent. The NSF’s budget increased by just under 2 percent.
“The NIH budget has lost 11.4 percent of its purchasing power in just 4 years, a very significant decline,” says John Morrison, chair of the Government and Public Affairs Committee of the Society for Neuroscience. “The budget for the National Institute of Mental Health [NIMH], which funds schizophrenia research, only went up .15 percent, so it did worse than the NIH budget overall. The National Institute on Aging budget, which funds Alzheimer’s research, only went up .16 percent. These are two areas that one would have thought would have been extraordinarily high priorities given the economic cost and the cost in human suffering, but in fact those institutes got hammered worse than most.”
Although the president’s budget request for Fiscal Year 2009, released in early February, is just an opening gambit in preparation for months of haggling with Congress, it shows little sign of reversing the trend: the $29.2 billion requested for NIH is identical to the amount that was eventually enacted this year.
Double or nothing
This year’s NIH funding stands in stark contrast to the heady days of 2003, when Congress and Bush joined forces to complete an ambitious 5-year doubling of the agency’s budget, according to Thomas Insel, director of the NIMH. “We’ve come to calling this the ‘undoubling,’” Insel says, “because that’s essentially what’s been happening over the course of 5 years.”
Both Lieberman and Morrison say that, for scientists, the flat budgets rolled out since 2004 have had the dispiriting effect of a bait and switch.
“There was considerable momentum in research initiatives and expansion of the research enterprise” during the doubling, says Lieberman. “A flat budget pulls the rug out from under much of the gains that were established and diffuses the momentum that had previously existed in the biomedical research community. To ramp things up, put additional money into them, and then slow things down, and throw people out of successful research programs and discourage new people from entering the medical research workforce, that’s not good long-term management.”
Morrison draws the same analogy—“Nobody would design an investment in a business in that way: invest at 15 percent a year for 5 years and then minus 3 percent, or zero percent, for 5 years,” he says—and he worries most about the fate of those just entering science. “When competition gets as brutal as it is now, where we’re only funding about 10 percent of the submissions, young scientists are just really up against the wall,” Morrison says. “They’re trying to get their first grant, and it’s really difficult to compete with somebody who’s been in science for 25 years. They are getting very, very discouraged, and I think this will have a profound effect on the next generation of American scientists.”
Insel agrees that the current funding environment will inevitably prompt talented young scientists to reconsider their commitment to research. “How do we keep from losing a generation, not only because they will have trouble getting funded, but because they see their mentors who are 5 or 10 years ahead of them having such trouble getting funded and spending all of their time writing grants?” he asks. “Not surprisingly, a young investigator may begin to ask, ‘Is this really what I want my life to look like in 10 years?’”
To stem the tide, Insel says, over the past 5 years the NIMH has been funding grants with unusual scientific promise, “if it appears that all we would gain from going through another round of review is that the grantsmanship would improve but the science wouldn’t change,” up to, and sometimes beyond, the 25th percentile. By doing so, he says, the number of new NIMH-funded investigators has remained fairly constant since he began his tenure in 2002. “On average, we have about 95 new investigators each year. In 2007 we were up around 98 in spite of having a flat budget. We got there because we reached much deeper into the pool.” However, Insel warns, “In 2008 we’re not going to make it. We’re going to fund fewer grants and fewer new investigators than last year. We just don’t have as many applicants with scores below the 25th percentile, and some of the proposals from new investigators aren’t really ready for prime time.”
Insel says that reaching further into the applicant pool is just one way the agency hopes to avoid an inevitable temptation to stay on safe, predictable ground in a time of tight funding and to provide support to innovative approaches and new technologies. “We believe that the biggest risk for us is to not take risks,” he says. “For the past 2 or 3 years, we’ve set aside a piece of our budget each year so we can capture grants that may not have done very well in peer review but we think represent really new, exciting opportunities. We make sure that these grants, which would otherwise not have been funded, have sufficient funds for at least 1 year.”
Nonetheless, Insel says, funding cuts mean hard choices. “We’re always asking where is the public health burden the greatest and where is the scientific opportunity the greatest. The areas where these answers overlap are where we want to make our investments.” For the moment, he says, these criteria favor schizophrenia research. “In 2008, we’ve decided to place additional emphasis on schizophrenia, to really push on some issues around the prodrome, around genetics, and keeping a focus on the cognitive deficits” of schizophrenia. “We don’t usually have a disease focus in a given year, but this was, for us, an area in which we felt a real push could move the field.”
The real cost of health care
Lieberman and Morrison express disappointment that the crisis in research funding has received little play in the 2008 presidential campaign compared to the rising cost of health care delivery. But they remain optimistic that a change in the executive branch may revive the generally positive relations between scientists and policy makers that have prevailed since World War II. “In my professional lifetime I’ve not experienced an administration that has been this unsupportive of the biomedical research mission,” Lieberman says. “By the law of probability this would have to improve.”
Insel believes one key to restoring funding is making the public aware that rising health care expenditures and declining research budgets are inextricably linked. “Many people view biomedical research as finding more expensive, high-tech treatments that will be accessible to fewer and fewer people and will continue to drive health care costs up,” he says. “It’s a public relations challenge that I don’t think has been fully addressed. Whether there will be a bipartisan movement to develop something like the Decade of the Brain or the doubling of the NIH budget again will require a clear articulation of the importance of making an investment, and, most of all, the costs of not investing. I don’t think the advocacy communities have made that argument convincingly.”
Until then, a certain degree of frustration is part of his job description, Insel says. “At the same time that the budget has stalled out in terms of its growth, the opportunities for scientific breakthroughs and discoveries have never been better. There’s an unfortunate mismatch; it’s like having a car that can go much faster and much farther, but you don’t have the gas you need to make it run.”—Peter Farley.