Austerity Shortchanges Cure for Kidney Diseases and Other Chronic Conditions

Budget austerity measures are imperiling funding for NIH research. This concerns me a great deal as a physician-scientist focused on providing the 20 million Americans with kidney disease the best care possible. Kidney disease is a devastating disease, and it’s costing taxpayers a fortune. When patients progress to kidney failure, otherwise known as end stage renal disease (ESRD), they require dialysis or a transplant. Although transplant is the optimal form of treatment for most patients, there aren’t enough donated kidneys for everyone who needs one, so most patients with ESRD (nearly 650,000) are stuck on dialysis.

I say stuck because most patients receive in-center dialysis treatment three times a week for three to four hours for each treatment. And because kidney disease causes other chronic diseases, such as diabetes, high blood pressure, and heart disease (80% of patients with ESRD have three comorbidities), patients are often shuttling between many doctor appointments and visits. Not surprisingly, only 1 in 5 patients on dialysis works, and many draw Social Security Disability Insurance (SSDI) benefits.

Here’s the kicker, ESRD—the only health condition that Medicare automatically covers regardless of age or disability—represents 7% of Medicare’s cost but less than 1% of the patient population. At $35 billion annually, the Medicare ESRD Program costs more than NIH’s entire budget, and for a treatment with grim outcomes. Fifty percent of patients with ESRD die within three years of initiating dialysis, and the leading cause of death of patients with ESRD is heart disease.

If we can prevent the progression of kidney disease or improve the care of patients with ESRD, that would reduce heart disease and other chronic conditions and yield significant Medicare and SSDI savings. But that requires sustained and steady increases for NIH, particularly for groundbreaking basic research, the building block for new treatments and cures. Instead we are moving backward.

For example, Benjamin Margolis, MD, a colleague at the University of Michigan Medical School, in Ann Arbor, is one of the leading investigators in the basic science of cells in the kidney tubules. His discoveries and research program have been critical for understanding how these cells are organized in order to maintain a normal balance of water, acid, calcium, potassium, protein (and many other substances) in all animals from flies to humans.

Dr. Margolis was an investigator in the Howard Hughes Medical Institute for 10 years, has been first or senior author on some of the most highly cited papers in understanding kidney cell biology, is internationally recognized for his research, has won an American Society of Nephrology-American Heart Association Young Investigator Award, and has presented over 100 invited lectures worldwide.

Dr. Margolis has continued to publish critical new research in top-ranked journals. His research has direct applicability to our understanding of polycystic kidney disease, one form of which is one of the most frequent genetic diseases in the world, affecting an estimated 12.5 million people worldwide. His research has been recognized by the Polycystic Kidney Disease Foundation (http://www.pkdcure.org/learn/multimedia/videos).

Unfortunately, Dr. Margolis’ research has not been funded in the past year. Although he was able to get some research support from the university, this highly productive investigator and his research program were shut down owing to lack of funds. Two highly promising young faculty researchers who were mentored by Dr. Margolis lost the opportunity to continue their research, despite having their own career development awards from NIH. Other highly productive members of his laboratory were also suddenly without a job.

This scenario is not uncommon. Highly productive senior investigators like Dr. Margolis are being forced to end their research careers because of research funding cuts. While disruptive and discouraging to senior investigators, the impact on junior investigators is barely imaginable. They see their mentors, who are often leaders in their fields, being forced to end productive research programs.

The takeaway for them is that careers in fundamental biomedical research are impossible. After all, when their heroes can’t succeed, how can they imagine success? The greatest tragedy is not that Dr. Margolis had to lock the door to his research laboratory, but that current and future trainees will now not even try to open the door to a biomedical research career.

I urge Congress to increase the budget caps and provide NIH steady and sustained increases year after year. That is absolutely essential for attracting the best and brightest minds to science, maintaining America’s position as the world leader in medical innovation, and curing our biggest healthcare challenges, including kidney disease.