The sequester and biomedical research – lessons for Europe

Transatlantic. The so-called sequester, automatic spending cuts across the board- have gone into effect in the US and also impact on the level of public funding for biomedical research. In a recent commentary in JAMA, Ezekiel Emmanuel comments on the decline of support for the NIH, which he believes goes far beyond the results of the spending cuts and can be traced back to four main factors. In this post, we would like to discuss to what extent his four main arguments also apply to the European scientific community.

The NIH as a model system. The large majority of the public funding in the US provided by the National Institute of Health (NIH) or one of its associated institutes such as the National Institute of Neurological Disorders and Stroke (NINDS) that provides much of the funding for epilepsy research including the EPGP and Epi4K project. Therefore, in contrast to Europe with its mixture of centralized European and national funding, the funding situation in the US is actually an interesting model system how the overall level of funding for research depends on the public support and political issues. In his commentary in JAMA, Ezekiel Emmanuel suggests that we are currently witnessing a “reversal of fortune” for biomedical research, as demonstrated by a declining support for the NIH. Emmanuel points out four factors that contribute to this decline.

We all grew up in an environment where we believed the support for research to be constant or increasing. In his recent commentary, Emmanuel points out that there might actually be a decreasing support for research in the future, alongside with expected budget cuts. Even if the overall political framework for science is probably more positive in the EU, we will need to be prepared to answer questions regarding the cost-effectiveness of what we are doing.

We all grew up in an environment where we believed the support for research was constant or increasing. In his recent commentary, Emmanuel points out that there might actually be a decreasing support for research in the future, alongside with expected budget cuts. Even if the overall political framework for science is probably more positive in the EU, we will need to be prepared to answer questions regarding the cost-effectiveness of what we are doing.

1 – Increasing politicization of science. Emmanuel points out that science in the US is no longer a bipartisan issue, i.e. an issue that both large parties agree on. Support for science or specific scientific projects has been politicized and therefore become dependent on who is elected and who is not. With scientific projects dragged into the political arena, they become volatile. However, this also makes large “bursts” of funding possible. Due to the mixture of funding sources in Europe and due to the heterogeneity of national funding guidelines and priorities, the politicization of science may occur in Europe only on a smaller scale.

2 – Lack of political champions for science. Emmanuel reminds us of the contribution of Senator Arlen Specter who once singlehandedly insisted on including a $10 Mio USD funding boost for the NIH in the American Recovery and Reinvestment Act (the “Stimulus”). He points out that similar political advocates are currently lacking in the US. Does this issue also apply for Europe? As the funding for European research is more heterogeneous, there is little possibility for any European politician to position him or herself as a champion of research support. Amongst the four factors pointed out by Emmanuel, this is probably the least relevant for Europe.

3 – Return of investment. Think of genome-wide association studies. You always have a good reason to ask for more samples and for more funding for these experiments.  Emmanuel points out that the NIH had actually received quite a funding boost in the past and that there might be a lingering feeling that there has been no return of investment. Even with more funding, biomedical science does not “deliver”. He indicates that the burden of proof has actually shifted and that promised advances are no longer accepted. The debate regarding return of investment is relevant to epilepsy research. When taking a bird’s eye perspective, decades of funding have not resulted in a higher proportion of patients with epilepsy who are seizure-free. While we have learned much about biology, meachnisms and genetics, we have little to show with respect to increasing the probability of seizure freedom, a phenomenon termed the “Brodie Ultimatum” in a recent commentary in Epilepsy Currents. In light of these numbers, my usual catchphrase “…will lead to novel diagnostic and therapeutic avenues, which will eventually benefit patients” does not really sound that good anymore. I do not have an answer to how to increase the return on investment, but we might want to be prepared to be confronted with this issue. To put it more bluntly, the clock for epilepsy genetics is ticking. We either translate our work into better patient care on a large scale or support will decline. Pointing out that patients with Dravet Syndrome are protected from a seizure provocation through lamotrigine will probably not be sufficient.

4 – Defending a research budget in the face of deficit. Given the trillion-dollar deficit in the US, Emmanuel highlights the fact that the research budget will have to compete with other budgets such as education or defense. Explaining why particularly research should be exempt from cuts will be difficult to justify. Likewise, the general tendency on this side of the Atlantic is uncertain given the current preference for austerity measures throughout the EU. For any politician on the European scene, defending an expanding research budget in the face of banking crises and imminent national bankruptcies will be difficult. While there is currently little panic in the research community with several large grants on the way, we might have to be prepared that the current level will not be maintained forever.

Solutions. In his commentary, Emmanuel suggests the following four solutions for the NIH, some of which also apply to the European research sphere. (1) Politicians and particularly political advocates will need to be “identified, educated and cultivated”. (2) The value of biomedical research will need to be explained better. Do away with empty phrases and be concrete on what you can deliver. There is a history of empty promises in biomedical research that the public is growing wary of. (3) Take care of the costs. If we spend millions on identifying genes for epilepsies, how will this eventually lead to a cost reduction for the health care system? We might dig out some arguments here and there if needed on grant proposals, but have we ever really looked into this? Do we have a concept on how 20,000 Euro spent on clinical genome sequencing will systematically reduce costs? (4) We need to learn how to be frugal, not only applying the next “exiting” technology, but also lowering costs and increasing value.

My comments. Many of the issues raised by Emmanuel only partially apply to Europe as the political system is different. However, his commentary has reminded me that biomedical research is potentially reaching a tipping point. Whereas biomedical research had always been considered sacrosanct in the past, particularly the growing needs for funding in biomedical research might be viewed much more critically in the future. Will we look back at this decade as the golden age of genetic research that eventually came to its end due to the lack of findings that can be translated?

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