Five to one, baby. One in five. No one here gets out alive. -- Jim Morrison
Every life turns tragic. All you have to do is wait long enough. (Confidential to Mr. Lizard King: Dude, five to one is one in six.) Nobody put it more poignantly than Susan Sontag, who wrote of the land of the well and the land of the sick, and how each of us will one day count ourselves among the citizens of the bad place. That crossing comes late for most, but it comes nonetheless. Our topic today is the return trip.
There was a time when a visit to the doctor was a death sentence. Granted, this was back when doctors believed humors ruled the roost and bloodletting was state of the art. But we should not be too smug. There is a variety of pathological experiences modern medicine remains powerless before. Sure, it can name them, diagnose them, perhaps even take fancy pictures of them. But knowing the name of the beast and being able to tame it are different animals indeed.
Yes, we are getting better at treating disease. But that didn't happen by magic. It happened by hard work. It happened by smarts. It happened by serendipity.
But most of all, it happened by funding.
The National Institutes of Health (NIH) is the primary source of funding for medical research in the United States. Most of this research goes on at universities. You think up an idea, send in a summary, the NIH has a panel of experts look at it and, depending on the score they assign your proposal, you get a couple of years of funding (or not). The process is decidedly more complicated than that -- have a read here if you'd like the full story on extramural funding -- but that's the basic idea.
The NIH is currently in crisis. Scientists face worst funding in 50 years, the head of the agency recently testified before Congress (source: Huffington Post, 03/03/15). In the best of times, the NIH could never fund more than about a quarter of the research proposals it received. Not because the rest are bad ideas; because there's no money. In recent times, that payline has fallen to single digits. The decline has less to do with economic downturn mythology and more to do with national priorities. For Republicans -- and, alas, we can lay this squarely on the Republicans -- are using agencies like the NIH as a punching bag to make themselves look good. Slashing programs that not only benefit every American, but whose complete elimination would do nothing to "balance the budget," the clarion call that gets them cheered to reelection.
If you want to balance the budget -- assuming that is your real intent -- you have to tackle the big-budget items. The current top expenditures of the federal government are Social Security, Medicare/Medicaid, and Defense. Interest payments and other mandatory spending make up another twenty percent. Here, have a pie chart I found on Wikipedia:
This is from 2013 but current allocations are similar. Funding for the NIH is an invisible sliver buried over in the "Non-Defense Discretionary" wedge. Cutting those crumbs will do nothing to balance the budget. On the other hand, cutting those crumbs is making it impossible for many laboratories to continue work. Grant application after grant application is now denied funding. Not because they're bad ideas; because there's no money. Faculty who have run productive research programs for decades are giving up. They have come to accept they will see retirement before they ever see another dollar of NIH support. For new researchers trying to get established, the outlook is bleaker still.
Scientists aren't stupid. They aren't afraid of hard work. They have simply been politically outmaneuvered. University research is supported by taxes, and too many voters have been sold the idea that taxes are at best unnecessary and at worst an evil. That if we were to eliminate taxes, the country would be a paradise where everyone would live in a mansion and ride a jet ski to work. A wonderland where interstate highways and air traffic control and cures for disease would just magically fall out of the sky. The only thing the government should fund is the military, Republicans tell us, and all other expenditures are unconstitutional or theft or worse.
It's an easy thing, selling people an idea they want to believe. Especially if it puts money in your pocket. Especially if the downsides won't be felt until the snake oil salesmen have moved on to the next town. If you believe what the Republicans are selling, you're not a bad person; you just haven't thought this through. LabKitty is here to help you think this through It doesn't take tricorn hats or an appeal to the founding fathers. We won't need fuzzy concepts like patriotism or sequestration. We have a simple tool for evaluating spending priorities.
We have arithmetic.
A Look at Some Numbers
The NIH is made up of a whole bunch of smaller agencies (note: InstituteS of Health) each having a specific focus. So there is the National Eye Institute for study of the eye, the NINDS that studies neurological disorders and stroke, the NCI working on cancer, and so on. We could look up the budgets of all these agencies and attempt to tally the number of suffers to whom their efforts potentially bring relief. Instead, let's just examine one. A big one: The National Cancer Institute. If there is a disease we can agree is a terror, cancer would probably be at the top of everyone's list.
In 2013 (the most recent year I could find all the numbers needed for our story), Congress allocated $4.8 billion for the NCI (source: www.cancer.gov). Let's compare this number to what current congressional Republicans deem is the only acceptable use of tax revenue. In FY 2013, the US defense budget was $640 billion (source: Wikipedia).
For every dollar Americans spend on cancer research, they give about $133 to the military. (Footnote: A more accurate ratio would be considerably higher. As the Wikipedia page on the US defense budget notes, $640 billion "... does not include many military-related items that are outside of the Defense Department budget, such as nuclear weapons research, maintenance, cleanup, and production, which is in the Department of Energy budget, Veterans Affairs, the Treasury Department's payments in pensions to military retirees and widows and their families, interest on debt incurred in past wars, or State Department financing of foreign arms sales and militarily-related development assistance. Neither does it include defense spending that is not military in nature, such as the Department of Homeland Security, counter-terrorism spending by the Federal Bureau of Investigation, and intelligence-gathering spending by NASA." However, $640 billion is the number we have to work with.)
How shall we evaluate these spending priorities? How to compare the challenges of cancer and defense? It seems to me that is straightforward: death. Defense is in the business of preventing death. So is cancer research.
For the last decade at least, the primary mission of the US military has been the War on Terror. Global terrorism spiked in 2013, with about 10,000 attacks and 18,000 fatalities reported world wide (source: http://www.bbc.com/news/world-30086435). Only one of the attacks and three of the fatalities occurred in the US, if we count the Boston Marathon bombing as foreign terrorism (authorities do not). There were also 127 US combat deaths in 2013 as part of Operation Enduring Freedom (source: www.icasualties.org). This gives us 130 Americans killed by terrorism in 2013.
The NCI estimates about 580,000 Americans died of cancer in 2013 (source: CA Cancer J. Clin 2013, 63:11-30).
I could go look up global cancer deaths instead of US cancer deaths -- if we're going to be the world's policeman, I suppose we're also obligated to be the world's physician -- but I suspect you get the point. Congress is spending 133 times less money on a threat that kills five thousand times more of us.
What are we to make of this imbalance? If the defense budget were reduced, would IEDs be exploding on main street? Would North Korea be shelling Seoul? Would Iran, emboldened by the removal of Saddam Hussein, push Israel into the Mediterranean? Hard to say. But what is certain is if you are killed by cancer you are just as dead as if you were killed by a bomb or bullet. Ask the temporary guests of a local hospice if they're happy the US defense budget is larger than that of the next nine largest countries combined, seven of which are US allies. See if a new mother who won't live to see her child graduate kindergarten thinks the $911 billion F-35 Joint Strike Fighter is money well spent. Explain to a child bald and suffering in Children's Hospital that we might have found a way to stop their disease, but instead we bought more tanks.
I realize daring to question America's military spending isn't going to make me any friends (LabKitty hates the troops!1!! is the phrase you're looking for). So instead, have some more arithmetic. The entire NIH budget these days is about $30 billion. There's more than 10 million households in the US with an income of more than $1 million (source: http://www.cnbc.com/id/101743657). By my reckoning, we could double the annual NIH budget with a quarter of a percent tax increase on households earning more than $1 million. That's about $2500 each. Less than one day's wage.
Note: Double the entire NIH budget, not just the NCI. Why not focus on cancer? Because there's no telling where the next breakthrough will come from. Some of the first chemotherapy drugs were discovered by chemists developing textile dyes. The leukemia drug vincristine was originally developed to treat diabetes. Cisplatin emerged from a study of the effects of electricity on bacteria. Tamoxifen started as a birth control pill. Baruch Blumberg discovered the link between chronic disease and cancer while studying blood antigens in Australian Aboriginals. A list of unintended scientific discoveries also includes X-rays, quinine, penicillin, viagra, and insulin. It's just the way research works.
In return, households earning more than $1 million get to dodge a bullet.
Not today, but someday. For disease is the great equalizer. An agent of chaos that is rudely disinterested in your bank account. Perhaps that reality is so horrific people simply refuse to acknowledge it. Why should I care about the NIH? I'm never going to get cancer. I'm never going to get cancer. Everyone says the same thing the first time they visit an oncologist. And by then, it's too late. All the money in the world can't buy a cure that doesn't exist.
Taxes have been justified on many grounds. Because they're necessary. Because they're the cost of society. Or because you don't have a choice. Taxes for medical research are a different kind of animal: they're self-interest. How odd that calls for increased defense spending go silent when the enemy doesn't carry a gun or wave a flag. An enemy that kills us by the thousands, its victims our families and friends and neighbors. As if the military is essential and inalienable, and medical research is some frill luxury. But time and time again it has proven its worth. Oncology to organ transplants, maternity to dentistry. Look back and see the advances. But look forward and see the challenges that remain.
Medical research is not a luxury, not an extravagance. Medical research benefits everyone. It's all that stands between you and a very bad day. A day that's coming for each of us, whether you realize it or not. A day everything will change.
The day your number comes up.
Get your No funding, No cures bumper sticker
Every life turns tragic. All you have to do is wait long enough. (Confidential to Mr. Lizard King: Dude, five to one is one in six.) Nobody put it more poignantly than Susan Sontag, who wrote of the land of the well and the land of the sick, and how each of us will one day count ourselves among the citizens of the bad place. That crossing comes late for most, but it comes nonetheless. Our topic today is the return trip.
There was a time when a visit to the doctor was a death sentence. Granted, this was back when doctors believed humors ruled the roost and bloodletting was state of the art. But we should not be too smug. There is a variety of pathological experiences modern medicine remains powerless before. Sure, it can name them, diagnose them, perhaps even take fancy pictures of them. But knowing the name of the beast and being able to tame it are different animals indeed.
Yes, we are getting better at treating disease. But that didn't happen by magic. It happened by hard work. It happened by smarts. It happened by serendipity.
But most of all, it happened by funding.
The National Institutes of Health (NIH) is the primary source of funding for medical research in the United States. Most of this research goes on at universities. You think up an idea, send in a summary, the NIH has a panel of experts look at it and, depending on the score they assign your proposal, you get a couple of years of funding (or not). The process is decidedly more complicated than that -- have a read here if you'd like the full story on extramural funding -- but that's the basic idea.
The NIH is currently in crisis. Scientists face worst funding in 50 years, the head of the agency recently testified before Congress (source: Huffington Post, 03/03/15). In the best of times, the NIH could never fund more than about a quarter of the research proposals it received. Not because the rest are bad ideas; because there's no money. In recent times, that payline has fallen to single digits. The decline has less to do with economic downturn mythology and more to do with national priorities. For Republicans -- and, alas, we can lay this squarely on the Republicans -- are using agencies like the NIH as a punching bag to make themselves look good. Slashing programs that not only benefit every American, but whose complete elimination would do nothing to "balance the budget," the clarion call that gets them cheered to reelection.
If you want to balance the budget -- assuming that is your real intent -- you have to tackle the big-budget items. The current top expenditures of the federal government are Social Security, Medicare/Medicaid, and Defense. Interest payments and other mandatory spending make up another twenty percent. Here, have a pie chart I found on Wikipedia:
This is from 2013 but current allocations are similar. Funding for the NIH is an invisible sliver buried over in the "Non-Defense Discretionary" wedge. Cutting those crumbs will do nothing to balance the budget. On the other hand, cutting those crumbs is making it impossible for many laboratories to continue work. Grant application after grant application is now denied funding. Not because they're bad ideas; because there's no money. Faculty who have run productive research programs for decades are giving up. They have come to accept they will see retirement before they ever see another dollar of NIH support. For new researchers trying to get established, the outlook is bleaker still.
Scientists aren't stupid. They aren't afraid of hard work. They have simply been politically outmaneuvered. University research is supported by taxes, and too many voters have been sold the idea that taxes are at best unnecessary and at worst an evil. That if we were to eliminate taxes, the country would be a paradise where everyone would live in a mansion and ride a jet ski to work. A wonderland where interstate highways and air traffic control and cures for disease would just magically fall out of the sky. The only thing the government should fund is the military, Republicans tell us, and all other expenditures are unconstitutional or theft or worse.
It's an easy thing, selling people an idea they want to believe. Especially if it puts money in your pocket. Especially if the downsides won't be felt until the snake oil salesmen have moved on to the next town. If you believe what the Republicans are selling, you're not a bad person; you just haven't thought this through. LabKitty is here to help you think this through It doesn't take tricorn hats or an appeal to the founding fathers. We won't need fuzzy concepts like patriotism or sequestration. We have a simple tool for evaluating spending priorities.
We have arithmetic.
A Look at Some Numbers
The NIH is made up of a whole bunch of smaller agencies (note: InstituteS of Health) each having a specific focus. So there is the National Eye Institute for study of the eye, the NINDS that studies neurological disorders and stroke, the NCI working on cancer, and so on. We could look up the budgets of all these agencies and attempt to tally the number of suffers to whom their efforts potentially bring relief. Instead, let's just examine one. A big one: The National Cancer Institute. If there is a disease we can agree is a terror, cancer would probably be at the top of everyone's list.
In 2013 (the most recent year I could find all the numbers needed for our story), Congress allocated $4.8 billion for the NCI (source: www.cancer.gov). Let's compare this number to what current congressional Republicans deem is the only acceptable use of tax revenue. In FY 2013, the US defense budget was $640 billion (source: Wikipedia).
For every dollar Americans spend on cancer research, they give about $133 to the military. (Footnote: A more accurate ratio would be considerably higher. As the Wikipedia page on the US defense budget notes, $640 billion "... does not include many military-related items that are outside of the Defense Department budget, such as nuclear weapons research, maintenance, cleanup, and production, which is in the Department of Energy budget, Veterans Affairs, the Treasury Department's payments in pensions to military retirees and widows and their families, interest on debt incurred in past wars, or State Department financing of foreign arms sales and militarily-related development assistance. Neither does it include defense spending that is not military in nature, such as the Department of Homeland Security, counter-terrorism spending by the Federal Bureau of Investigation, and intelligence-gathering spending by NASA." However, $640 billion is the number we have to work with.)
How shall we evaluate these spending priorities? How to compare the challenges of cancer and defense? It seems to me that is straightforward: death. Defense is in the business of preventing death. So is cancer research.
For the last decade at least, the primary mission of the US military has been the War on Terror. Global terrorism spiked in 2013, with about 10,000 attacks and 18,000 fatalities reported world wide (source: http://www.bbc.com/news/world-30086435). Only one of the attacks and three of the fatalities occurred in the US, if we count the Boston Marathon bombing as foreign terrorism (authorities do not). There were also 127 US combat deaths in 2013 as part of Operation Enduring Freedom (source: www.icasualties.org). This gives us 130 Americans killed by terrorism in 2013.
The NCI estimates about 580,000 Americans died of cancer in 2013 (source: CA Cancer J. Clin 2013, 63:11-30).
I could go look up global cancer deaths instead of US cancer deaths -- if we're going to be the world's policeman, I suppose we're also obligated to be the world's physician -- but I suspect you get the point. Congress is spending 133 times less money on a threat that kills five thousand times more of us.
What are we to make of this imbalance? If the defense budget were reduced, would IEDs be exploding on main street? Would North Korea be shelling Seoul? Would Iran, emboldened by the removal of Saddam Hussein, push Israel into the Mediterranean? Hard to say. But what is certain is if you are killed by cancer you are just as dead as if you were killed by a bomb or bullet. Ask the temporary guests of a local hospice if they're happy the US defense budget is larger than that of the next nine largest countries combined, seven of which are US allies. See if a new mother who won't live to see her child graduate kindergarten thinks the $911 billion F-35 Joint Strike Fighter is money well spent. Explain to a child bald and suffering in Children's Hospital that we might have found a way to stop their disease, but instead we bought more tanks.
I realize daring to question America's military spending isn't going to make me any friends (LabKitty hates the troops!1!! is the phrase you're looking for). So instead, have some more arithmetic. The entire NIH budget these days is about $30 billion. There's more than 10 million households in the US with an income of more than $1 million (source: http://www.cnbc.com/id/101743657). By my reckoning, we could double the annual NIH budget with a quarter of a percent tax increase on households earning more than $1 million. That's about $2500 each. Less than one day's wage.
Note: Double the entire NIH budget, not just the NCI. Why not focus on cancer? Because there's no telling where the next breakthrough will come from. Some of the first chemotherapy drugs were discovered by chemists developing textile dyes. The leukemia drug vincristine was originally developed to treat diabetes. Cisplatin emerged from a study of the effects of electricity on bacteria. Tamoxifen started as a birth control pill. Baruch Blumberg discovered the link between chronic disease and cancer while studying blood antigens in Australian Aboriginals. A list of unintended scientific discoveries also includes X-rays, quinine, penicillin, viagra, and insulin. It's just the way research works.
In return, households earning more than $1 million get to dodge a bullet.
Not today, but someday. For disease is the great equalizer. An agent of chaos that is rudely disinterested in your bank account. Perhaps that reality is so horrific people simply refuse to acknowledge it. Why should I care about the NIH? I'm never going to get cancer. I'm never going to get cancer. Everyone says the same thing the first time they visit an oncologist. And by then, it's too late. All the money in the world can't buy a cure that doesn't exist.
Taxes have been justified on many grounds. Because they're necessary. Because they're the cost of society. Or because you don't have a choice. Taxes for medical research are a different kind of animal: they're self-interest. How odd that calls for increased defense spending go silent when the enemy doesn't carry a gun or wave a flag. An enemy that kills us by the thousands, its victims our families and friends and neighbors. As if the military is essential and inalienable, and medical research is some frill luxury. But time and time again it has proven its worth. Oncology to organ transplants, maternity to dentistry. Look back and see the advances. But look forward and see the challenges that remain.
Medical research is not a luxury, not an extravagance. Medical research benefits everyone. It's all that stands between you and a very bad day. A day that's coming for each of us, whether you realize it or not. A day everything will change.
The day your number comes up.
Get your No funding, No cures bumper sticker
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