Photo: Spencer Platt | Getty Images
While on the presidential campaign trail in the fall of 2015, Donald Trump and right-wing radio host Michael Savage took turns bashing the National Institutes of Health (NIH) on Savage’s radio show.
Savage, who’s declared that 99 percent of autism cases are frauds and that veterans with post-traumatic stress disorder (PTSD) are “weak,” “narcissistic,” and “losers,” said he wanted Trump to consider him to run the NIH, the largest public funder of biomedical research in the world.
While Savage may or may not have been kidding, Trump replied seriously, “Well, you know you’d get common sense if that were the case, I can tell you, because I hear so much about the NIH, and it’s terrible.”
Soon after he was elected, Trump proposed cutting funding for the NIH by more than $7 billion, or 22 percent, to $26 billion.
But a broad coalition of congressional members from both parties flatly rejected Trump’s proposal and voiced their support for the institutes, which fund medical research in areas ranging from cancer to neurological diseases.
Democratic Sen. Richard Durbin of Illinois said the President’s proposal “would have crippled American innovation in medical research, delayed new cures and treatments, and brought NIH funding to its lowest level since 2002.”
When Lamar Alexander, the Republican senator from Tennessee, announced at a Senate hearing last September that Congress was dismissing Trump’s proposal and instead increasing the NIH budget by some $2 billion, the audience loudly applauded.
Failing to cut the NIH budget
President Trump has now tried twice, and failed twice, to slash the institutes’ budget.
And many wonder if he will try again next year.
Two weeks ago, after threatening a veto, Trump signed the $1.3 trillion fiscal year 2018 spending bill from Congress. He didn’t like it, but he signed it.
“I say to Congress: I will never sign another bill like this again,” the president said at a news conference.
The bill, a boon for medical research, includes a $3 billion increase in funding to the NIH.
The budget, which raises the agency’s fiscal 2018 budget to $37 billion, a 15-year high, reportedly includes increases in funds for every NIH institute and center.
It also includes $400 million for mapping the human brain (BRAIN initiative) and $290 million for the All of Us precision medicine initiative.
The bill also earmarks $1.8 billion for Alzheimer’s research, a $414 million increase over the previous fiscal year.
Good news for scientists, patients
Scientists who rely on NIH for funding can exhale and get to work, at least for now.
“Overall, the increase is good news, it is very welcome news, because as always, the cost of disease far outweighs the amount we invest to treat disease,” Lawrence Goldstein, PhD, director of the University of California San Diego Stem Cell Program and scientific director of the Sanford Consortium for Regenerative Medicine, told Healthline.
Goldstein, whose work is dedicated to unlocking the mysteries of Alzheimer’s disease and finding treatments for the condition, said the budget windfall was a pleasant surprise.
“These funds are helpful because there is a lot of work to be done, and it takes funding to do it,” he said. “NIH is the lynchpin for the development of new therapies all around the world.”
Goldstein said funding to find treatments for disease should never be a partisan issue and noted that members of Congress in both parties are the ones the American public should thank for this science-friendly budget.
“There are members of Congress, in both parties, who really get it,” he said. “The NIH has been relatively favored over the years. But we need to keep driving that message. It’s up to scientists and patient advocates, he added, to make the point that “NIH is not an entitlement program, it is an investment in our nation’s health.”
Kenneth P. Serbin, PhD, a professor of history at the University of San Diego and a volunteer advocate since 1998 for the Huntington’s Disease Society of America, carries the gene for that disease.
He said the budget news is good news, but it could be even better.
“An increase in NIH funding — which has been seriously neglected for years — is welcome, in particular areas that have to do with the brain, our most important natural resource,” Serbin told Healthline.
“Alzheimer’s is a critical area and related to research in [Huntington’s disease] and other neurodegenerative diseases. However, a society truly dedicated to scientific advance and medical breakthroughs should put $100 billion or more into the NIH,” he added.
Cancer research funding
The latest federal budget also includes a $275 million increase for the National Cancer Institute (NCI), which is part of NIH.
It’s not a ton of money in the grand scheme of things, cancer researchers tell Healthline, but it’s far better than what the president had in mind.
Chris Hansen, president of the Cancer Action Network at the American Cancer Society, said in a statement that this bill offers an opportunity to accelerate the pace of innovation and progress against a disease that is expected to kill more than 600,000 Americans this year.
“The increased resources come at a critical time as researchers are on the cusp of many promising new cancer diagnostic tools and treatments, including those that harness a patient’s own immune system to fight the disease,” Hansen said.
This increase coupled with first-time funding for the Food and Drug Administration (FDA) Oncology Center of Excellence, promises to maximize the nation’s investment in medical research and ensure those advancements make it as quickly as possible from the lab to patients.
“We commend lawmakers for their strong, bipartisan dedication to consistent and continual research funding reflected in this budget. Their efforts are sure to help spur groundbreaking research for years to come,” Hansen said.
He added that this budget also boosts cancer prevention and early detection programs, which have struggled with flat or falling funding.
“This includes a nearly $8 million increase for the Breast and Cervical Cancer Early Detection Program, a joint federal-state effort that has screened 5.3 million uninsured or underinsured women since its inception, but which has historically struggled with inadequate resources to reach many more who are eligible,” Hansen said.
The budget also allocates $5 million for the Centers for Disease Control and Prevention (CDC) Office on Smoking and Health (OSH). This agency leads federal efforts to reduce tobacco-related death and disease, and preserves the FDA’s regulatory authority over the full range of tobacco products granted under the Family Smoking Prevention and Tobacco Control Act.
Some of the most significant research in the cancer sector at present is in blood cancers, specifically in immunotherapy.
Dr. Alexis A. Thompson, president of the American Society of Hematology (ASH), the world’s largest professional society of hematologists, said this budget is good news for patients with blood cancers.
“For over a decade, the NIH faced nearly flat funding, undermining its ability to fund thousands of meritorious medical research grants. Each of these unfunded research grants represents a potential cure that may never be discovered,” Thompson said.
Thompson said lawmakers should be applauded for “greatly increasing funding for the NIH and the vital research programs that the agency supports.”
Thompson added that the financial support shown in this budget to the Cancer Moonshot initiative and the All of Us precision medicine initiative is “encouraging, and ASH looks forward to collaborating with the NIH to ensure the success of these landmark programs.”
Groundbreaking cancer research is costly
At Moores Cancer Center at UC San Diego, Dr. Ezra Cohen, professor of medicine and associate director for translational science, and his colleagues are working on several translational cancer treatment studies that are close to fruition.
One of them deploys the much-publicized CAR-T cell immunotherapy technology to fight cancer stem cells, which are difficult to kill.
Many scientists believe CAR-T represents the best hope yet as a potential cure for some cancers, perhaps in combination with other drugs. It’s a technology in which a patient’s own T cells — essentially your body’s immune system — are engineered to fight cancer.
To date, CAR-T has worked best on lymphomas and leukemias, but Moores Cancer Center is looking at how CAR-T can fight problematic solid tumors such as pancreatic cancer, ovarian cancers, triple negative breast cancer, and head and neck squamous cell carcinoma.
In this new type of immunotherapy, patients’ cells would be equipped with a special receptor that recognizes and targets cancer stem cells, whose powerful survival abilities often render standard treatments ineffective.
Cohen expects to begin human trials for this new way of utilizing CAR-T in a year to 18 months.
But, of course, this all costs money. Lots of money, no matter how you slice it.
“This budget is good news and we are certainly happy to receive more money for research, but it looks like much of the major increases are not necessarily earmarked for cancer,” Cohen told Healthline.
“NCI gets an increase, but a lot of this is for specific programs. The NCI increase is not a huge boost, for example, but again, it is a boost,” he observed.
For example, Cohen said that the NCI’s Cancer Moonshot to accelerate cancer research, which was championed by former Vice President Joe Biden, was announced as a $1 billion project, but that even a billion dollars does not go as far as one might think.
“When it all gets broken down and we see where the money goes, it is not that much. But the reality is that as a nation, we have to do this. We have to lead the world with this cancer research. As a generation, we have to defeat this disease,” he said.
Cohen is concerned about the future and whether the funding for these new cancer therapies will still be there.
“I think what we have learned is that you cannot depend on what this administration says, but as far as politics, I will stop my comments at that,” he said. “But I am worried, as I am sure many are, because if we are looking at a finite amount of resources and they are in a way shrinking, the amount of money government has to spend, and I am deciding where to allocate funds, what are the programs that have the least immediate impact?”
Cohen said he and his colleagues have learned that “the research they do today will impact human disease in 5 to 10 years from now. And this is when the current administration will no longer be there to face the fire of stalled cancer research programs, or the questions about why the U.S. is no longer leading the world in innovation.”
The current group “will be out of office, “he said, “and that scares me. Things like cancer research can be defunded now, and the decision makers will not be around to answer these difficult questions.”
Medical marijuana money
The new budget doesn’t just defy the president, it also serves up a rather resounding raspberry toward Attorney General Jeff Sessions and his anti-marijuana agenda.
The bill includes language introduced by Senator Patrick Leahy (D-Vermont) to prohibit the Department of Justice and its affiliated agencies from prosecuting legal and compliant medical marijuana systems, businesses, and patients.
“We are very pleased to see that neither Congress nor the White House bent to the will of Attorney General Jeff Sessions when it comes to his anti-marijuana crusade,” Justin Strekal, political director of NORML, said last week in a statement.
Strekal noted that there are 30 states that have authorized the use of medicinal marijuana, serving more than 2 million patients nationwide who rely on these programs.
“At a time when the majority of states now regulate marijuana use, and over 6 out of 10 voters endorse outright legalizing the plant’s use by adults, it makes no sense from a political, fiscal, or cultural perspective to allow Sessions to attempt [to] put this genie back in the bottle,” Strekal said.
The bill states that federal funds cannot be used to prevent states from “implementing their own state laws that authorize the use, distribution, possession, or cultivation of medical marijuana.”
Rep. Earl Blumenauer (D-Oregon), the co-chair of the Congressional Cannabis Caucus, said in a statement, “While I’m glad that our medical marijuana protections are included, there is nothing to celebrate since Congress only maintained the status quo. These protections have been law since 2014. This matter should be settled once and for all. Poll after poll shows that the majority of Americans, across every party, strongly favor the right to use medical marijuana.”
He continued, “Instead, Attorney General Jeff Sessions is doubling down on the failed War on Drugs, and Republican leadership in Congress — led by Chairman Pete Sessions — is stonewalling. They’re ignoring the will of the American people by blocking protections for state adult-use laws and cannabis banking. They even refused our veterans access to lifesaving medicine.”
Where else will the money go?
The new budget also includes $400 million for the BRAIN Initiative. That’s a $140 million increase over last year.
In addition, the bill allocates $315 million for children’s hospitals graduate medical education (CHGME) payments, an increase of $15 million, and $1.6 billion for community health centers, $135 million more than last year.
The bill also includes $290 million for the All of Us precision medicine initiative. That is a $60 million boost over the previous year.
And it provides $996 million in funding for the 21st Century Cures Act, a biomedical research funding bill that had strong support from both Republicans and Democrats and was signed by President Barack Obama in December 2016.
Congress does its own thing
Goldstein said that historically, a president’s budget request to Congress has been “dead on arrival.”
“Then Congress does its own thing,” he said. “That is what we saw this year and I would not be surprised if that continued.”
Goldstein added, “Congress has to appropriate the money and make a budget, and hopefully do a decent job. I believe many members of Congress understand how vitally important this research is and we hope they continue to recognize this.”