The 2013 Outlook for Research Funding

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Current federal deficit reduction efforts could lead to more cuts to U.S. medical research funding. Since the November 2012 election, Congress has been consumed with averting the “fiscal cliff” on January 2, 2013.

As of press time, Congress and President Obama had not reached a deal, but most experts agree that one would be made either before or after the January deadline. If before, the agreement would most likely employ a two-step process whereby Congress would agree with the president to allow the 2003 tax cuts to expire for the top 2 percent of wage earners and postpone the automatic $1.2 trillion across-the-board cuts to federal discretionary programs for the first 6 or 9 months in 2013 to allow time to identify areas in the federal budget for savings or cuts and to revise the tax code.

If the United States goes over the fiscal cliff before Congress and the president reach a deal, other issues will come to the forefront that must be dealt with: principally, funding the remainder of the Fiscal Year (FY) 2013 budget that expires on September 30, 2013, and raising the “debt ceiling” before the United States reaches the legal limit of how much debt the federal government can assume. Congress will also take up FY 2014 budget and appropriations bills in the spring.

As Congress and the president deal with all of these issues, ASN will be on the front lines to remind lawmakers that medical research has already done its part and that more cuts to research funding will not balance the budget.

“ASN is greatly concerned that more cuts are on the horizon for the National Institutes of Health (NIH) and medical research at other federal agencies as talks intensify on the U.S. budget and debt ceiling,” said ASN Research Advocacy Committee Chair John Sedor, MD.

The White House Office of Management and Budget (OMB) projected NIH would see another cut of $2.5 billion, or 8.2 percent, and the loss of up to 2300 research grants if there is no deal to avert the fiscal cliff. National Cancer Institute Director Harold Varmus, MD, claims cancer research would actually sustain cuts closer to 40 percent since NIH has decided to fund administrative costs and current obligations before new grants in the event the United States goes over the fiscal cliff.

Whether 8.2 percent or 40 percent, NIH Director Francis Collins, MD, PhD, declared that the cuts “would be devastating for many investigators who are seeking to continue programs that they have had funded in the past and are back for their competing renewal, or who are starting things that are entirely new; and I think the burden would hit particularly heavily upon first-time investigators who are seeking to get their programs up and going.”

Today, only one in six applications (18 percent) are approved for NIH research funding—an all-time low—and the average age of a scientist receiving their first grant is 40 years. More cuts to medical research would not only mean the loss of promising research, they could jeopardize the position of the United States as the global leader in research, with countries such as China doubling down on investment in this area. For these reasons, ASN has been aggressively advocating for a balanced approach to deficit reduction that does not rely on further cuts to research.

Funding for patient outcomes at risk?

Cuts would also hamper other research agencies like the Patient-Centered Outcomes Research Institute (PCORI) established by the 2010 Affordable Care Act (ACA). PCORI’s mission is to help “fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed health care decisions.”

Although the Supreme Court upheld the constitutionality of the ACA last June, funding for PCORI would still be subject to sequestration (the technical term for the fiscal cliff). The White House OMB estimated in September that the Patient-Centered Outcomes Research Trust Fund, which funds PCORI, would be subject to a 7.6 percent cut, amounting to $30 million from the $390 million fund in FY 2013. Despite the uncertainty, PCORI continues to forge ahead. After laying infrastructure groundwork and selecting research priorities in 2011 and 2012, PCORI is poised to begin tackling its mission in earnest in 2013 if its funding is not decimated by sequestration.

In May of 2012, PCORI adopted a revised “National Priorities for Research and Research Agenda” after considerable public input from many different stakeholders during a 54-day comment period. ASN recommended that PCORI consider kidney disease as a model for chronic disease research because kidney disease affects individuals throughout the human lifespan, as well as racial and ethnic minority populations. The care of pediatric and adult patients with CKD provides a model for care of patients with common diseases who have complex medical histories, multiple comorbidities, and are cared for in a variety of settings at a high cost. The full letter is available at http://www.asn-online.org/policy/.

PCORI adopted several of ASN’s suggestions, including a recommendation to make disparities in the development and progression of chronic illnesses, including CKD, a core research priority. In addition to addressing disparities, PCORI’s five national priorities include assessment of prevention, diagnosis, and treatment options; improving health care systems; communication and dissemination research; and accelerating patient-centered outcomes research and methodological research. The complete PCORI report is available at http://www.pcori.org/news-room/.

In November 2012, PCORI adopted 47 revised methodology standards to guide the conduct of patient-centered outcomes research. A full report, providing context for the revised methodology standards, will be available in the spring. Researchers conducting PCORI-funded studies will be required to adhere to the methodology outlined in this report.

Signaling a shift from planning-related activities to more research-oriented activities, PCORI also authorized the development of three research funding announcements in November. PCORI will support studying treatment options for uterine fibroids, the safety and benefits of treatment options for severe asthma, and fall prevention in the elderly. The agency is also currently considering input from the public on two additional topics for funding that it will announce in early 2013. More information about funding opportunities is available at http://www.pcori.org/funding-opportunities/.

As PCORI moves ahead with or without a fully funded budget, ASN will continue to advocate the importance of investments in research by all federal agencies that improve the health of kidney patients.

January 2013 (Vol. 5, Number 1)