This is the fourth in a series of special issues taking a closer look at the factors shaping modern medicine.
Federal Budget Cuts Threaten Medical Research—
and Much More
In a lab on the first floor of the Kornberg Research Building, a group of researchers is using stem cells to repair the nervous system of a mouse—a pioneering feat that could lead to a treatment for multiple sclerosis. Across the street, in the Saunders Research Building, a researcher scours genetic data on a computer screen, hunting for clues about a heart disorder that kills with little warning. In the Wilmot Cancer Center, researchers are studying a drug that may halt acute leukemia in elderly patients—a vulnerable group for whom current therapies often fail.
Across URMC, researchers are making big contributions to our understanding of disease and to the development of new treatments. And the success of these research programs has raised the national profile of our medical school, helping us attract top talent to our community and build clinical programs that deliver the region’s most advanced health care.
But the benefits don’t stop there. The strength of our research programs has helped anchor UR as the region’s largest employer, providing economic stability to the community as other major employers have downsized. More than 3,400 URMC employees work full-time in biomedical research (if our research enterprise were a stand-alone business, it would have twice as many employees locally as Bausch + Lomb and nearly as many as Paychex). Most of these programs are supported by $145 million in federal grants from the National Institutes of Health. The bulk of those dollars are spent right here in the Rochester area as the medical center purchases goods and services from local companies, and as researchers spend their paychecks on cars, groceries, clothing and other goods. In fact, economists estimate that our $145 million in federal grants actually results in more than double that amount in local spending—and that’s a conservative estimate. One study suggests that every dollar of NIH-funded research contributes seven dollars to the nation’s economy, as medical discoveries are translated into commercial products such as new drugs and medical devices, and as medical progress provides cost savings to our society.
Yet despite all of these benefits, a storm is brewing. Funding for researchers at Rochester and at universities across the nation is being cut dramatically as the federal government tightens spending. In this issue of Pulse, we take a look what these cuts could mean for our research programs, for the medical center as a whole, and for the Rochester community.
The bulk of URMC research—and the salaries of the faculty and staff who conduct it—is paid for by the federal government in the form of grants from its medical research agency, the National Institutes of Health (NIH). The largest funder of biomedical research in the U.S., NIH awarded more than $25 billion in grants last year to universities across the nation.
But earlier this year, as part of a sweeping effort to reduce the federal deficit, Congress pulled back the NIH budget by 5.3 percent. When the cuts took effect on March 1, the NIH lost $1.6 billion, nearly all of which will be deducted from grants that have already been awarded to university researchers. URMC is expected to lose $7.7 million this year, and that’s just the start; Congress has signaled an additional 8.5 percent cut for next year, which would slash another $12.3 million from URMC’s research programs.
These deep, painful cuts follow ten consecutive years of small, bare-bones budget increases at NIH that haven’t kept pace with inflation—meaning that the budget has been shrinking relative to the rest of the economy. NIH director Francis Collins put it powerfully, recently estimating that the NIH has lost 20 percent of its buying power over the last decade.
“The reason this year’s cuts are so alarming is that, at most medical schools, research budgets already have reached the breaking point,” said Mark Taubman, M.D., dean of the School of Medicine and Dentistry. “Federal funding is shrinking, while at the same time our costs—for salaries, benefits, equipment, information technology, and everything else—continue to grow.”
Academic medical centers across the nation are trying a range of strategies to cope. Many have undertaken aggressive cost cutting measures, including pay and hiring freezes. Nearly all are trying to offset the decline in NIH funding by looking elsewhere for monies, amping up their fundraising efforts and by seeking additional support both from industry and from private foundations. And some have begun to reduce the size of their research programs, laying off staff or not replacing researchers who accept jobs elsewhere.
URMC, like most medical centers, also uses a substantial portion of the revenue from its clinical services to help offset the costs of its education and research missions. In nearly every academic medical center, any transfer of dollars from the hospital to the medical school is a touchy subject.
“I think that some people question it because budgets are tight, and getting tighter. But they also question it because they don’t appreciate the extent to which our clinical programs benefit from being part of an academic institution,” said Steve Goldstein, president and chief executive officer of Strong Memorial Hospital and Highland Hospital.
It’s a symbiotic relationship, each mission aiding the other. For example, Goldstein points out that URMC’s academic and research programs are directly responsible for our national rankings in specialties such as neurology and neurosurgery, urology, and several pediatric subspecialties.
“The fact that many of our programs are consistently ranked among the best in the nation gives us an advantage in the local market,” Goldstein said. “Patients choose us because of our expertise.”
In addition, this national reputation helps us recruit physicians, particularly in certain high-demand subspecialties.
“We’re often competing nationally to attract top talent,” Goldstein said. “Our medical school’s teaching and research programs make us a desirable place to practice.” He notes that many top physician candidates maintain active research programs and are developing new treatment approaches, making URMC’s academic programs a strong incentive to come here.
Beyond boosting the institution’s reputation and luring top doctors, the medical school pays off another way: Ensuring that the entire community has an adequate supply of physicians.
“Our graduates go on to serve the entire community,” Taubman added, noting that more than 40 percent of physicians practicing at Strong, Highland, Rochester General, and Unity completed medical school or residency at URMC. “You can start to see how endangering research and the medical school has profound ripple effects; it’s connected to so many things our community takes for granted.”
But perhaps the strongest argument in support of biomedical research is very reason we do it in the first place: To fight disease.
“Over the past 40 years we’ve reduced deaths from heart disease by half and deaths from childhood cancer by 68 percent. And someone diagnosed with HIV today can expect to have the same life expectancy as the general population,” said Steve Dewhurst, chair of Microbiology and Immunology and vice dean for research. “The progress we’re making on so many fronts speaks for itself. It’s incredibly difficult for all of us to watch that progress being jeopardized by budget cuts.”