Investment in Cancer Research and Biomedical Science Saves Lives, Fuels Innovation and Boosts the Economy
Cancer Progress Report 2012: Contents
This Report celebrates the many ways we are making research count for patients by turning scientific discoveries into better approaches for preventing, detecting, diagnosing and treating cancer. In the past 12 months alone, we can point to significant progress: continued reduction in the overall cancer death rate; forward strides in cancer prevention, including FDA approval of one new drug for cancer prevention; critical advances in cancer treatment, including eight new drugs for cancer treatment and four new uses of previously approved drugs; and the beginnings of integration of whole-genome sequencing in the clinic, which promises to change the practice of oncology. In addition, scientists at institutions in every single state across the Nation reported a myriad of basic science discoveries that are revealing novel, unanticipated insights that may well offer the keys to the next major advances for cancer patients.
NIH is the Catalyst for Progress Against Cancer
The NIH is one of the most important enterprises of this nation. It is responsible for seeking fundamental knowledge about the nature and behavior of living systems and the application of that knowledge enhances public health, lengthens life, reduces the burden of illness and disability and saves lives. It does this by supporting exceptional scientists and clinicians at more than 3,000 universities, medical schools, medical centers, teaching hospitals, small businesses and research institutions across the country. In fact, more than $25B (80%) of its $30B budget is provided to these independent researches who are working in communities in every state.
Core to the NIH’s mission and essential to the entire cancer research ecosystem is the fundamental research that it supports. While industry is willing to invest in late-stage research to bring advances in scientific understanding to commercial realization, only the federal government can fund the basic research that marks the beginning of the pipeline. Industry-sponsored R&D is rightfully performed with a near-term financial return in mind, but at the NIH the returns are measured in lives both saved and improved with benefits accruing over a longer time span.
Cancer research is primarily funded through the NCI, one of the 27 institutes and centers that make up the NIH. During its 40-year history, NCI-funded research has driven significant advances in the understanding of cancer and our ability to prevent, detect, diagnose and treat it. In addition, NIH- and NCI-supported research has spurred advances in health care that have significantly reduced the burden of cancer and transformed the lives of a growing number of cancer patients, the 13.7 million cancer survivors in the U.S. alone. This remarkable progress would not have been possible without the long-standing, bipartisan commitment of our nation’s policymakers to invest in research through the NIH (see Sidebar on
While the NIH does not attempt to realize a financial return from the research it funds, it does in fact generate significant financial returns. Thirty years ago, the Bayh–Dole Act was passed, allowing universities and investigators to lay claim to intellectual property developed using federal research dollars. This has helped spawn the multibillion dollar biotech sector, where entrepreneurial researchers have created companies from their discoveries, adding high-skilled jobs and creating new industries as a direct result of federal research investments which aid in moving basic findings to effective treatments in the clinic.
One of the most paradigm-shifting federally funded biomedical research projects in the past 20 years was the Human Genome Project, which serves as a case study in how research investments generate significant financial and societal returns. Much as NASA’s lunar mission spurred rapid advances in communications and aeronautics that quickly opened new doors to widespread use of associated technologies, the sequencing of the genome has fundamentally changed the way we think about human health and enabled entirely new approaches to research. Analysis of the 15-year, $3.8-billion project indicated that the investment resulted in as much as $796 billion in associated economic activity and raised personal income by $244 billion. In 2010, as many as 310,000 jobs owed their existence to the effects of this project (117). The information and technologies emerging from the Human Genome Project radically changed researchers’ approaches to studying cancer, a disease driven by genetic abnormalities, and as a result the pace of progress has been accelerated dramatically.
Most federally funded research projects are not as large as the Human Genome Project, and the estimated 141-fold return on investment is hard to match, but in the aggregate the $30 billion of NIH-sponsored research in 2010 is estimated to have supported close to a half a million jobs and to have spawned an additional $69 billion in economic activity (118). As our Nation seeks to recover from a long recession and a period of high unemployment, cutting funding to a proven economic generator is simply poor fiscal policy.
Some research advances have led to new interventions that can balance rising health care costs by avoiding needless treatments. One such technology is FDG-PET imaging, which improves staging and reduces unnecessary surgeries for Hodgkin’s disease (119). Another example is molecular diagnostic tests that predict which patients are unlikely to suffer a cancer recurrence and can safely forego costly treatment (120). Continued application of our growing knowledge will undoubtedly expand on these examples and provide additional opportunities for cost savings and improved health.
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Dwindling Research Budget and Threats of Drastic Cuts Threaten Progress for Patients, Economy
At a time of constrained budgets, scarce federal dollars must be invested wisely. Funding cancer research and biomedical science through the NIH and NCI is a wise choice that will improve both America’s health and prosperity, and supporting these agencies should remain a top priority. However, in practical terms, the NIH budget has been steadily shrinking since 2003 due to biomedical inflation. In fact over the past decade, the NIH has effectively lost nearly 20% of its ability to support live-saving research.
While the erosion of the NIH budget has been a slow and chronic problem, we face an acute challenge as 2013 begins. Because of budgetary deficits, an automatic budget-cutting action, known as a “sequester” (see Sidebar on
Sequestration), will occur beginning on January 2, 2013, if Congress does not take action to avert this crisis. The sequestration is slated to cut all federal discretionary budgets, which includes the NIH, by approximately 8%. A cut of this magnitude would have an adverse effect on every aspect of the NIH, sparing no Institute, Center or program from an immediate substantial reduction in funding.
In testimony before Congress, NIH Director Francis Collins, M.D., Ph.D. described sequestration’s effect on the NIH as potentially “devastating,” adding that if this occurred “2,300 grants that NIH had planned to fund could not be awarded.” In addition, Dr. Collins said that this would result in success rates falling to historically low levels and would be devastating for many investigators, particularly first-time investigators who are seeking to get their programs up and running.
What is so concerning is that this threat of draconian cuts to the NIH is occurring at a time where the potential for acceleration of discoveries in cancer research have never been greater. Federal investments in basic research have enabled the Nation’s scientists to build upon each other’s work and make substantial progress in preventing, detecting, diagnosing and treating cancer, but the prospect of significant cuts threatens to undercut this momentum.
The initial scientific breakthrough that ultimately led to the cancer chemotherapeutic drug imatinib occurred in the 1950s, but with the available technology and understanding available at that time, it took 40 years to convert that basic science discovery into a life-saving treatment. Today, thanks to the knowledge that research has provided about normal and cancer cell biology, as well as advances in technology, the time from basic discovery to an effective treatment is now much shorter. For example, the development and FDA approval of two recent targeted cancer drugs approved in 2011, took as little as nine and four years. Reduced funding in this era would also mean arrested and abandoned research (see Sidebar on
Sequestration) when we are best able to reap the benefits of our prior investments.
Unfortunately, the decline in U.S. funding for biomedical research comes at a time when other nations are giving a higher priority to biomedical research and some are significantly increasing their overall investments in science and technology. For example, China has pledged to invest more than $300 billion in biomedical research over the next five years (121). If current trends continue, in only a few years, Chinese investment in life science research will be double that of the U.S. A lack of commitment on the part of the U.S. to prioritize and maintain its investment in science threatens our Nation’s long-standing global leadership in innovation.
The declining NIH and NCI budgets are also creating an environment where researchers face numerous disincentives to continue in, or even enter into, research careers. It means the loss of many young cancer investigators who will choose other careers instead of scientific careers because of a lack of funding. These disincentives are resulting in a loss of taxpayer-funded training and are adversely affecting the Nation’s ability to maintain an optimal workforce for the future of cancer research.
Furthermore, current fiscal austerity means that the success rates for an investigator being awarded a research grant are diminished. In fact, current investigators face an all-time low in funding success rates, which has the detrimental effect of researchers proposing lower risk ideas which are often less innovative (121). This cycle creates missed opportunities to drive the science forward, slowing the translation of benefit to the patient, which as a country we cannot tolerate.
It is important to highlight that NIH funding of research across the Nation results in a local economic impact that is at least double the amount sponsored by the federal government. This multiplicative effect works in reverse as well, and the threatened sequester cut of $2.4 billion would likely drain twice that amount from local economies. The ecosystem that produces biotech startups and new jobs would be thrown in reverse at a time when job creation is a social and economic priority.
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Progress Report 2012 Contents