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Investing in Medical Research: Resource-intensive, Long-term and Worth It

As Congress heads into summer recess, we will continue to see some heady days for medical research. The 21st Century Cures Act has provided a light at the end of a long tunnel of stagnant growth in NIH funding. While not a miracle "cure," the bill is a good start to reversing the trend of stagnant federal support for medical research — setting aside $1.75 billion a year, for five years, for an NIH innovation fund. (See bill's text here.)

The bill was championed and collaboratively shepherded through the House by Representatives Fred Upton, Republican from Michigan, and Diana DeGette, Democrat from Colorado, and garnered strong support from both sides of the aisle — approved in the House by 344-77 (170 Republicans and 174 Democrats). While we don't yet know how all this will turn out with a parallel bill in the Senate still under development, and appropriations in both houses still pending, there is reason for hope. Seeing the names of so many Democratic and Republican leaders supporting the bill on social media and in the steady stream of headlines in major news outlets has been described by research advocates as, "remarkable," and "unimaginable."

This federal commitment to reinvigorating the nation's medical research enterprise is shared by others — industry, private foundations, patient organizations, and even a new generation of philanthropists. Understandably, private funding largely focuses on specific diseases, conditions, or other interests of the funders. Two relatively recent developments that underscore the growing trend of expansive private investment in research are the $100 million dollar private donation to the Sanford-Burnham Medical Research Institute and the broader privatization in American science recently noted by the New York Times.

There is another group also committed to materially supporting medical research - the academic medical community itself. A recent AAMC study determined that academic medical centers contribute on average 53 cents for every one dollar of sponsored research support that they receive (primarily from the NIH - the world's largest funder of medical research). The institutions' investments cover all the critical elements necessary to provide a fertile environment where scientists can conduct research. These elements include additional salary support for scientists, bridge funding, start-up and recruitment costs for new faculty, support for facilities and administrative costs that are un- or under-recovered on grants, and explicit cost-sharing required by some sponsors.

These institutional investments are no substitute for federal funding. Still, these resources are part of the overall investment of academic medicine to the missions of advancing health through providing high-quality clinical care to the sickest and the most vulnerable, educating and training new generations of physicians and scientists, and advancing research. It is important that the public understands that this is not research conducted at the NIH itself, but rather conducted every day by physicians and other clinicians, scientists, medical residents, medical and graduate students, and postdoctoral fellows at academic medical centers and universities across the nation. Over 50% of NIH extramural funding goes to researchers and programs in academic medical centers that are working daily to bring hope to patients around the globe.

This investment is resource-intensive, long-term, and worth it. Medical research can be serendipitous and unpredictable; it takes money and time. But in the long-run, it's quite a bargain, having increased overall life expectancy, improved survival of many cancers, decreased deaths from cardiovascular disease, developed new diagnostics, treatments, and, for many, cures. And advances will continue with increased federal support.

As a recent example, through medical science and the development of DNA sequencing technologies, we are now able to identify the molecular fingerprints of certain cancers, resulting in a more definitive diagnosis and potentially a much more targeted treatment, perhaps saving patients from having to go through several unsuccessful trial treatments. This single extraordinary advance is built on many small, unglamorous steps that take time and rarely make the news, but can ultimately lead to innovative new diagnostics and more targeted treatments.

Like the small steps in science, the investment by academic medicine in medical research has yet to make a headline in any major news outlet; it has not made the breaking news events of dramatic and (sometimes not so dramatic) proportions, and it would not be included in any "rapid return on investment" category. Yet, without it, many medical advances would be delayed or might not happen at all.

So, while celebrating the remarkable efforts of the federal government's investment in research, we also celebrate the equally remarkable commitment of academic medicine and of the public in supporting medical research.