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AAMC Reporter: January 2007
A Word from the President:
"What Comes After a Hard Landing?"
When it comes to federal funding for the National
Institutes of Health (NIH), it no longer is a world of predictable
"boom-bust-boom" cycles. Today, the funding
picture is much more complicated, particularly given
the political and fiscal realities we face.
When the completion of the NIH budget doubling
coincided several years ago with the financial challenges
of post 9/11 America, we knew it could lead to what
many in our community called "a hard landing." It is
proving to be even more than that. In recent years, the
NIH budget has been declining in real dollars when
inflation is factored in, while medical schools have
greatly expanded their research capacity. As NIH
Director Elias Zerhouni observed in the November 17,
2006, issue of Science, this has led to the tragic confluence
of a surge in grant applications with no immediate
hope of funding most of them.
In recent weeks, two signs for optimism have emerged:
voters clearly voicing desire for a change in our country's
direction, and last-minute passage of the NIH reauthorization
bill before the 109th Congress adjourned
in December.
What do these events mean for our community?
Should we take them as signs that the nation now is
ready to increase its commitment to the NIH and reaffirm
research as a public good? Or, should we be deeply
worried about future NIH funding given the nation's
massive structural deficit ($248 billion in fiscal 2006
alone), and the difficult challenge lawmakers face in
setting national priorities?
The answer, I believe, is "both." While the public—and
many in Congress—share our community's commitment
to research and have deep faith in the power of
science, our nation's unsustainable fiscal course presents
a massive challenge. Here are five steps I believe we
must take to help us navigate through this period
of uncertainty:
First, we must communicate our progress and tell our
success stories.With 55 percent of the NIH extramural
budget awarded to scientists at our medical schools and
teaching hospitals, we have a unique opportunity—and
responsibility—to convey the benefits resulting from
that research partnership. A major success story came
last month as the news was announced that breast cancer
diagnoses dropped 15 percent in 2002-03 because
of NIH-funded research that led to fewer women using
hormone replacement therapy.
At the national level, we are continuing to help policymakers
and the public better understand our NIH
partnership through the AAMC Fulfilling the Promise
campaign. At the local level, we are showcasing the work
of medical school and teaching hospital investigators
through research festivals and appreciation days. We
must be careful, however, not to over-promise or raise
expectations unrealistically. In providing information
on new advances and research now underway, we must
explain that research advances require sustained investment
over time. It is a marathon—not a sprint!
A second step is to broaden our research portfolios by
drawing on alternative sources of federal funding, such
as the Agency for Healthcare Research and Quality,
the Centers for Disease Control and Prevention, the
Department of Defense, the Department of Energy,
the National Science Foundation, and others, as so
many of our institutions already do. However, we all
must face the fact that these agencies and departments
are in the same situation as the NIH in competing for
scarce federal research appropriations.
Third, we must pursue relationships with "non-traditional"
partners, including state houses and local
chambers of commerce, and enlist their support in
advocating for NIH funding. In addition to helping
these new partners better understand the critical role
medical schools and teaching hospitals play in conducting
life-saving research, we must demonstrate
how the work of our institutions is an economic
engine driving the national as well as local economies.
According to an updated analysis by the firm of Tripp
Umbach, the combined economic impact of AAMC-member
institutions in 2005 equaled more than $451
billion and accounted for more than three million
full-time jobs (directly or indirectly) nationwide. This
new analysis, which provides similar data on a state-by-state basis where AAMC members are located, also
shows how our institutions—through medical education,
business development, patient services, and
research—generated more than $20 billion in total
state tax revenue that same year.
Fourth, to the extent we rely upon complex research
partnerships with the private sector, we must demonstrate
accountability by rigorously managing potential
financial conflicts of interest (COI). Preserving public
trust in what we do is essential. As a community, we
have made tremendous progress on this issue and,
through the work of the AAMC Task Force on Financial
Conflicts in Clinical Research, have articulated principles
and developed clear guidelines for managing individual
and institutional COI. Nevertheless, we still have
ground to gain in terms of public trust, and the AAMC
will team this year with the Association of American
Universities in a new joint advisory committee to
explore this issue further.
Fifth, we must demonstrate that we are good stewards of
the diverse resources we already receive from tuition and
appropriations, grants and contracts, and physician and
hospital revenues. The public, unfortunately, is largely
unaware of the degree to which our institutions must
subsidize the research they undertake. We need to point
out that our institutions are using their own limited
resources to fully share the burden of building our
nation's scientific infrastructure.
As the 110th Congress convenes this month, it is impossible
to predict what will happen with regard to future
policy or NIH funding. What comes next after this hard
landing will depend in no small part on the actions we
take. Above all, we must remember that we live in an age
of unparalleled promise for medical research, and must
continue communicating the critical role our medical
schools and teaching hospitals play in conducting that
research and improving the nation's health.
Darrell G. Kirch, M.D.
AAMC President
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