The Sequester and the “Lost Generation” in Health Research

How it could rob our future of important advancements

Published on March 6, 2013by Abdul El-Sayed

With $28.7 billion in domestic discretionary spending cuts, a portfolio that includes the CDC, NSF, and NIH, the future of American health science is in trouble.

Beyond the direct loss in research funding, these cuts will reach deep into the future—potentially leading to a scientific ‘lost generation’ by devastating early-career scientists and robbing society of decades of scientific breakthroughs they would have made.

The United States has long been the world’s leader in innovative approaches to important health questions. That’s because consistent, generous funding for health science has enabled scientists to pursue their work consistently with relative trust in the availability of funding through competitive research grants.

However, research budgets over the past decade have not kept up with inflation. Despite this, however, competition for new funding has heated up. The pressure of this competition falls most squarely on young scientists. In an interview with the Washington Post, Elias Zerhouni, former director of the NIH explains why: Only about 20 percent of NIH money in a particular year is allocated for new grants, and nearly half of that money goes to grant renewals for promising projects. That leaves only about 10 percent in total for new projects—meaning only 10 percent available for grants for new, up-and-coming scientists.

While it makes sense from the NIH’s perspective to fund established scientists to support their work in which the institution has already invested, it is more questionable from the perspective of maintaining a strong pipeline of young talent. By forcing bright young talent to compete so fiercely for so little funding, many of the brightest young minds are necessarily excluded—robbing society of the discoveries they potentially would have made. And not only does the competition itself exclude bright young talent, but the very prospect of this competition, and potential failure, is enough to drive potential stars away from what they perceive to be risky careers in research to more secure, lucrative career choices, such as medicine.

The sequester compounds this pressure. As Zerhouni puts it: “If you take 8 percent of that 10 percent, it’s going to come from new science, new people, young investigators.” This 8 percent cut will devastate young scientists at the cusp of their first independent research grants—many of whom won’t get that make-or-break funding that would have ushered them through the pipeline.

One young scientist with whom I spoke is an epidemiologist who specializes in mental health. An assistant professor at a top university, she is certainly one of the brightest young epidemiologists in the country. Now, however, her proposal for a K-award, a career development grant that funds early-career scientists through their first five years of independence, hangs in the balance. “I have worked for more than two years on this grant and received a great score. To see all of that effort potentially go to waste is very disheartening,” she said. “I feel like I am stuck in exactly the wrong place at the wrong time.”

Her situation accentuates the loss our society will have to bear as a result. Autism is one of our most pressing health enigmas—a problem to which this young scientist has dedicated much of her career. We’re not sure what’s causing it, but the epidemic continues to grow, with estimates suggesting that the rate of autism increased by nearly 17 times between 1992 and 2003 alone. Without funding, the important work this young scientist is leading to some day understand autism’s causes could halt—with it, the potential discoveries she could have made.

And the list of important problems for which the next generation needs good scientists is long. Obesity, diabetes, cardiovascular disease, and cancer continue to claim millions of deaths each year. Steady increases in the rate of mental health disorders, punctuated by events such as the shooting at Newtown, remind us that we know little about the brain. In fact, the President just announced a decade-long scientific campaign to map the human brain to better understand diseases that affect more and more Americans each year, like depression and Alzheimer’s. Yet without talented young scientists to take up the reigns, who will carry it forward?

Many of the medical breakthroughs we take for granted every day—from the baby aspirin and the Lipitor so many Americans take to prevent cardiovascular disease to the technologies doctors rely on to care for us if we find ourselves in the hospital—had their start as federally funded research studies. Many of them were carried forward by young scientists. But this sequester will force a large number of those young scientists out of the field for lack of funding. It will rob society of the important future discoveries they would have made.

Ironically, while a 5 percent across-the-board cut may seem fiscally responsible right now, slashing health science funding may, in fact, have hampered one of our best opportunities to contain the federal budget in the long run. That’s because the fastest growing item in the federal budget is Medicare, largely a result of rising healthcare costs. Federally funded research in public health, health informatics, and cost-cutting technologies has been focused on addressing that problem for some time. But with funding cuts dissuading promising young scientists from carrying this research forward, its potential to help solve our fiscal problems suffers. And so do we.