On November 11, 2008, Research!America and its partners in Your Candidates-Your Health 2008 met to review the project and look ahead to the landscape for advocacy following the election. Listen to a podcast of the event.
The Honorable John Edward Porter, Research!America's chair, spoke about how the outcome of this historic election could positively impact funding for research for health. His remarks are available here.
Former National Institutes of Health Director Elias Zerhouni, MD, sent remarks, which were handed out to attendees and are available here.
Bart Moore, of the National Journal, presented research on how Hill staffers respond to advocates and lobbyists and how the election outcome might affect those relationships. His slides are available for download here (PDF).
Research!America's Vice President of Science Policy & Outreach Stacie Propst, PhD, gave an overview of the Your Candidates-Your Health initiative and its outcomes. Her slides are available for download here (PPT).
The Honorable John Edward Porter Comments on the Post-Election Landscape
The most exciting and, perhaps, significant election of my lifetime has taken place and Barack Obama, of Chicago, Illinois, has been chosen by the American people to lead our country.
I'm excited and inspired by the possibility that he will be able to bring us together---bring Congress together---to address the enormous problems which face us.
One of those enormous problems----the one that concerns all of us today---is six straight years of real funding decreases for medical research.
We are all very hopeful of turning around the nightmare of those years.
But we do not really know whether President Obama will put science at his table---at his left hand (he's left handed)---And whether medical research will be very high on his priority list and reflected strongly in his budgets, speeches, and policies.
We do have some indications from the campaign:
He gave promising answers to the questions put to him by Research!America through YourCandidatesYourHealth.org and by ScienceDebate2008.com.
He gave a promising picture in his discussion of health and science on his campaign website. He specifically promised to double all science research funding over 10 years.
To my recollection, he was the only candidate in the general election debates to mention research.
He also indicated his strong support for expanding federal funding for embryonic stem cell research.
And he stated his opposition to teaching Intelligent Design in our public schools.
Finally, he has chosen a very strong team of science advisors, three of whom come from the life sciences, to his campaign and now to the transition: Harold Varmus, Gil Ommen, Peter Agre, Don Lamb, and Sharon Long
But do any of these promises and indications mean anything, in light of the current economic crises?
We have $10.3 trillion in national debt and are facing, perhaps, a deficit for fiscal 2009, of as much as a trillion dollars, may be more.
The next President will inherit greater problems than anyone since Abraham Lincoln.
In addition to the economy and all that portends for the average American, we have:
Two wars going on, problems in each, and many in the Muslim world hating us.
Infrastructure that has been neglected and has deteriorated to the point of national crisis.
A relationship with our allies, in many cases, in tatters.
A dependence on foreign oil that has shown us to be extremely vulnerable---particularly to many who wish us ill.
A healthcare system that is inefficient and very costly, and 46 million Americans who have no health insurance coverage.
Democracies disappearing or in deep trouble in our own hemisphere.
Global climate change threatening the future of life on the planet, with our own country as the greatest contributor to the carbon release causing it.
A Medicare trust fund soon to be in deficit just at a time when baby boomers are about to retire and add tremendously to the draw on the system's resources, which are simply not sustainable.
A social security system that has long-term sustainability problems as well, and for the same reasons.
Now that I've depressed us all, the real question is whether there is any real hope that NIH - and all the science research funding agencies of the federal government - can achieve at least real budgetary increases in the next Administration?
Yes, of course there is.
I believe that the strong messages from the American people coming out of this election are:
End the partisan bickering and obstruction.
Sit down together and address the country's problems.
Bring the best people the nation has to offer, regardless of party, to serve in the new cabinet and positions of importance in the new administration.
Put aside philosophy and get pragmatic about solutions that can work for our country.
If Congress won't co-operate, go over their heads to appeal to the American people to make them do so.
In each case, I think Barack Obama has heard and reflects the message of the people.
The selection of the new cabinet members followed by the new President's first State of the Union Address, probably in mid‑to‑late February, will show whether we have the kind of leadership we need.
For science, I would look to how quickly the new President selects and announces his science advisor and whether he intends to nominate that person as head of the Office of Science and Technology Policy - OSTP; whether it will be a cabinet level position; and whether OSTP will be housed in the Old Executive Office Building near the White House.
Next, listen to what the new President says about science in his State of the Union speech.
I like to imagine what I would like to hear in that speech, then try to mobilize science to work to make that ideal happen and to urge the new president's science advisors to have the President embrace that ideal.
Our new President has already indicated that he will propose a large new stimulus package.
That package is expected to include new spending on the economy, education, alternative energy, and infrastructure.
In education, it should address a public education system that fails to educate our children, particularly in science and mathematics, where we must see real progress in the years ahead.
Perhaps the best part of the economic crisis is that our kids all won't want to be stockbrokers anymore.
Maybe they'll want to be scientists instead.
But, whatever else is part of the plan, I believe it must include---we must work to make it include---making up the ground lost to inflation during the present administration in funding for research.
This science-funding part of any plan of the type I envision would probably be the least expensive piece.
I talked with Harold Varmus, about this last Tuesday.
We need to get this concept, or something like it, in the mind of the new president if we possibly can.
Clearly there is a lot in our country that needs our focus and commitment in a bipartisan, problem-solving way.
Where would the money come from to pay for such a plan?
A lot of it will, until we get the economy turned around, have to be borrowed.
We will not be able to do - at least in the short term - everything that needs to be done.
But we can roll up our sleeves and get started.
Spending by government is all about choosing priorities.
In the end, priorities will be chosen, and money will be spent.
And I'm talking now about regular annual appropriations, in addition to any stimulus packages or supplemental appropriations that may be offered.
Priorities will be chosen and money will be spent.
For the next two years, and maybe longer or much longer, the White House and both houses of Congress will be controlled by the same party.
Under this scenario, the President's budget becomes very important.
If it isn't adopted by Congress almost as is, it will likely provide a floor for departmental, agency, and programmatic funding.
The overall discretionary spending total suggested by the President is, of course, very important to the allocation for Labor, H where NIH is funded.
Beyond the budget process are the appropriations, the stimulus, any supplemental, and not to be forgotten is the CR for FY09 expiring March 6.
These are our targets and a great deal of work lies ahead.
All politics is truly local.
Each of us spends large amounts of time and effort to energize scientists, our local members, the business community, the media and others all to impact policymakers at home.
But we can and do coordinate and guide their efforts through our work here in Washington.
We need to better coordinate our efforts and communicate with each other here in the capital.
Howard Garrison at FASEB has many of our group representatives sitting down regularly to do just that, and I commend him for it.
The purpose is not that we necessarily use the same approaches, tactics, and messaging.
A variety is actually better, in my judgment.
But we can vet what works and what doesn't, which targets should be covered and whether they are, who might be on our side and who are less likely to be.
We can simply communicate with each other about what is going on and work more closely to achieve our common purpose: increased funding for medical research.
Those of you who are not part of this group and want to be, talk to Howard. Howard, if you need more room for a larger group, we can make one of our new large conference rooms available at Hogan & Hartson on a regular basis.
After we have made up the ground lost in the Disaster, one suggestion:
Every year in the past we have spent a great deal of time determining what should be "the number".
My suggestion for your consideration: 3% real.
That's 3% plus BRDPI, or biomedical research and development inflation.
That is the historic rate of growth in NIH funding over all its history up until the time of the doubling. It's infinitely reasonable and defensible.
Its what all of us had hoped and expected after the doubling had been completed.
Let's discuss this early, and see if we can't find common ground.
Again, I'm talking about a rate after the lost ground has been recovered.
So, an exciting, inspiring new President from Chicago, whose heart, at least, we believe is in right place regarding funding for science research.
A strong majority of his party controlling both houses of Congress
An economy in real trouble and domestic programs---including our own---stagnated after six years of war and neglect.
The challenges are great; our work is cut out for us.
But, again, priorities will be chosen and money will be spent.
We must see that it is spent wisely.
Thanks for listening to me.
Elias Zerhouni, MD, Comments on the Post-Election Landscape
First let me apologize for not being able to be with you today.
Second, let me thank Research!America, Mary Woolley and John Porter for their continuing leadership. NIH could not be successful without the support of a great stakeholder community like yours which I have come to deeply appreciate during my tenure. The sheer diversity and strength of NIH's community of stakeholders is, in my view, a strategic asset for NIH and its ability to fulfill its many missions.
Mary asked me to share some observations and advice about priorities given the government transition and the overall economic context likely to affect NIH.
I believe that the following would be important issues to focus on:
Going from more short term to longer term priorities, I would think that it is important to keep a laser like focus on:
- The economic Stimulus Package...we have been fortunate to see support throughout Congress in favor of NIH during the last supplemental in 2008 ($150M) and thru the joint resolution in 2007 despite a CR (+$787M). The upcoming Stimulus Package is an opportunity to recover some more ground. We have made a strong case that NIH with its current number of meritorious but unfunded grants could rapidly and effectively support the national economy in a matter of weeks by rapidly deploying these merit based and already peer- reviewed grants to almost every academic community thru the country at a time when many academic institutions are in real difficulties given the drop in value of their endowments, the stagnant federal funding, the high tuition costs many parents and students can no longer afford in this economic climate and constrained healthcare revenues. This is as important an economic activity as any now being considered by the new administration thru the potential stimulus strategy and NIH is truly one of the most capable agency in delivering an economic stimulus of great value that remains based on merit. Language already exists in the Senate for a 1.2 B supplemental. Remember that by many estimates, a dollar of NIH funding translates in approximately 2.5 dollars of associated economic activity not counting the long term downstream effects on health and the industry. This line of argumentation is certainly something this community should consider developing further.
- Work on focusing the attention of the new administration on identifying and nominating a permanent director as early as possible. Although the team at NIH under acting director Dr. Raynard Kington is superb and very capable of effectively functioning even for a long transition, no agency of this importance should be left without permanent leadership for long. Having taken my job after a 2 and a half year interim, I speak from experience. One of the reasons I decided to leave before the election was in part to create a sense of urgency in the transition team for working on this important appointment.
- The 2009 budget. The hearings this year have led both houses of Congress to propose approximately inflationary level increases in the 2009 budget language. Given the economic circumstances it will become very important to continue to articulate the need for NIH's budget to, at a minimum, keep up with inflation and state ever more clearly, as I often have, that the NIH budget is not an optional subsidy but one of the most valuable investments the federal government has made over the years. The NIH community simply cannot agree that it is just one of many other options for subsidization and need to articulate its rationale much more consistently with strong supporting evidence.
- Focus on supporting specific initiatives to interest to all of NIH. Examples are the National Children study, Rare and Neglected Diseases, Transforming the effectiveness of translational sciences based on extraordinary progress and opportunities that have come out of basic research while sustaining our strong basic science portfolio and promoting greater involvement of patient organizations, the common opportunity fund for high risk/high reward initiatives ( aka the roadmap==a personal favorite as you have surely guessed ..!)
- Continue to expound on the vision of NIH as a transforming force for healthcare which has to move from the current paradigm reactive, late, curative, episodic type of care that is too costly to a more predictive, personalized and preemptive medicine that has a chance to improve not only the value but also the costs of healthcare. NIH is a part of the solution to the long term problem of healthcare costs as well as that of US competitiveness in what is likely to become the number one and fastest growing economic activity in the world over the next ten years: Healthcare!
- Last but not least and one of the most important priority in my opinion is to specifically increase funding for early stage scientists from all disciplines of science by allocating a specific budget beyond that of the current research agencies. It is probably the most defining strategic action for the long term viability and worldwide competitiveness of the US in the life and other sciences. I hope that the new administration will understand this issue early in its tenure and do something to reverse the current trends. While at NIH, we modeled these trends which all point to a more aged workforce that is unlikely to be replaced as the baby boomer generation retires over the next 10 to 15 years and may leave our country in a less competitive position than we are today. The same urgency applies in my opinion to the issue of the STEM education system which needs profound revamping if we are to continue to train the best and brightest scientists of the future.
I hope these observations are helpful to you. Again I am sorry not to be able to be with you today to discuss these further. —Elias Zerhouni