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The GOP Budget and Cancer -- Why New Research Is at Risk

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The budgetary hot-air wars gripping Washington have spotlighted all the elements that have degraded of 21st century politics: Apocalyptic threats of a government shutdown, high-decibel debates over budgetary irrelevancies (the drive to defund Planned Parenthood), angry denunciations of do-nothing government bureaucrats and vapid presidential slogans ("Win the Future").

Even when the congressional fiscal follies momentarily take a serious turn, an abstract tone dominates these floating numbers games involving slashing tens of billions. Budget arithmetic turns into an alternative reality as numbers are tossed around disconnected from real-world implications for federal programs.

Missing is an honest discussion of how potential cutbacks undermine governmental programs that both conservatives and liberals traditionally support.

A prime example is the $5-billion National Cancer Institute (NCI), part of the $31-billion National Institutes of Health (NIH). Aside from ideologically pure libertarians who probably think that Thomas Jefferson went too far with the Louisiana Purchase, no one believes that battling cancer should be left to the private sector and the vagaries of the profit motive. Since the Cancer Institute (like the NIH) spends nearly 80 percent of its money on grants, it is difficult to portray these medical research agencies as exemplars of bloated Big Government.

The arbitrary nature of the budget battles means that NIH is on the chopping block along with the rest of discretionary domestic spending. The problem is that even a small percentage cut in biomedical research disproportionately hobbles funding for new research projects. This counter-intuitive point was at the heart of an interview I had last week with Harold Varmus, the director of the National Cancer Institute and (full disclosure alert) a friend.

Few in government know as much about biomedical research as Varmus, the co-winner of the 1989 Nobel Prize for Medicine and the director of the NIH during the Clinton years. Varmus is not in the business of offering dire warnings to Congress ("I don't like to whine about this stuff") or engaging in budgetary antics like the Washington Monument ploy.(During a budget crisis decades ago, the Interior Department supposedly decreed that the first thing that had to go was tourist visits to the Washington Monument).

"The most important new thing we do every year is to make new awards to people with new ideas," Varmus said. "Yet we have obligations to people who got grant awards last year, the year before and the year before that." With grants lasting as long as five years, Varmus explained, the National Cancer Institute is locked into long-term commitments. NCI also helps fund a national network of leading cancer centers (like Dana-Farber and M.D. Anderson), which treat about 15 percent of the nation's cancer patients. Throw in funding clinical trials, offering medical training programs and supporting the NCI's in-house research – and there is not much give in the Cancer Institute's budget.

That is why new grants are so vulnerable as the government lurches from continuing resolution to continuing resolution. From his days at NIH, Varmus operates on the rough rule of thumb that "the system works well if you are funding one-third of your new grant applications." These days, the NIH as a whole is backing only maybe one-sixth of new grant requests. "When you're only funding 10 or 12 percent," Varmus said, "you really can't make the distinctions between applicants that we're being asked to make. So everyone gets very conservative – the experts who review these things tend to make very conservative decisions."

After a dramatic expansion between 1998 and 2003, the budget for the entire National Institutes of Health (as well as the NCI) has been essentially flat for nearly a decade. Adjusting for inflation, NIH's buying power is at roughly 2002 levels. After the failure of the Democratic Congress to pass any appropriations bill for the current fiscal year and with the House Republicans recently slashing $1.6 billion (5.2 percent) from the NIH budget, Varmus has no idea where spending levels for the Cancer Institute will end up. "What's unprecedented for me is to have a continuing resolution that is really a cut," he said. "That would put us back to 2008 spending levels."

While there are gambits that Varmus is using to maintain flexibility for new research ("We do a little skimming and give everyone a haircut to try to keep the grant numbers up"), he and his colleagues at NIH do not have much room for maneuver. As he puts it bluntly, "The number of new grants gets severely curtailed even with a 2-to-4 percent reduction." With no more than 20 percent of NCI's budget devoted to new grants, even a $300-million cut in funding would send shock waves through the nation's cancer research community.

There is a larger point here than pleading for more money for cancer research, even though we all have friends and loved ones who have died all too young from the disease.

Federal domestic spending consists of thousands of program lines – many far more worthy than others. By taking a meat cleaver to the budget, House Republicans are making only the crudest distinctions between government programs. This kind of fiscal Neanderthal-ism may play well with the voters who ousted Nancy Pelosi as House speaker. But it is no way to run a government – or to fight cancer.

Follow Walter Shapiro on Twitter (lucky you).
Filed Under: Budget, Congress

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STARMAN

The black plague was a boom to civilization during the middle ages. So many people died that labor was scarce, worker's pays tripled and quaddrupled, land was abundant and almost everyone could own their own land. People were no longer poor and starving. Maybe the republicans are taking their ideas from that era. Kill off all the old, poor, sick, and disabled, then watch the deficit fall, and everybody gets rich.

March 02 2011 at 11:11 AM Report abuse -1 rate up rate down Reply
marfister

Larrynyrd - you are right on the mark, I am reposting your comment on my facebook page.

March 02 2011 at 10:42 AM Report abuse -3 rate up rate down Reply
larryvnyrd

If we could get a small, low tax government, with no real labor Unions. No social safety net such as Minimum wage, food stamps or housing assistance , no Governmemt interference with any business such as pollution control or workplace safety, workers comp etc. The and Onlly then could We be HAITI. They have all that and it doesn't work no matter how many Fat drug addled radio talk show hosts claim it will. We need to raise taxes and pay our bills. There I said it, I didn't vaporize, I'm still standing here.

March 02 2011 at 8:17 AM Report abuse +5 rate up rate down Reply
1 reply to larryvnyrd's comment
kympathy

You are so right - we are becoming 3rd world - Hey! I've got a better idea - How about we confiscate and stop paying pensions to all current and former senators, Reps, Cabinet members, etc - they get a salary ONLY for the time served? That would put a lot back into the budget. I also thought there was a no double dipping law, but our higher level government employees do it all the time. It's ironic that when the GOP goes after everyone's job security and pensions, they don't go after their own, and they do this in the name of "saving jobs".

March 02 2011 at 12:24 PM Report abuse +2 rate up rate down Reply
Alex Vallas

The GOP/Tea Party leadership have a habit of "shooting first and then aiming and speaking first and then thinking" (if they think). Apparently it is a habit carried over from the Bush Administration. There appears to be a lack of basic analysis of their decision making, i.e, cause and effect and root causes. The GOP has proposed cutting funds for WIC (the program that provides proper nutrition to poor expectant mothers). It is virtually axiomatic that poor nutrition produces premature infants. Those weighing under two pounds will require extraordinary and extensive neonatal care. Further, those infants/children will be subjected to far more illinesses throughout their teens compared to healthy infants. Depending on the mother's future economic status, the burden will fall on either the taxpayer or insured.
The GOP wants to cut funding for education. That is absurd in a period when the US trails numerous other developed (and not so developed) countries in science, math and language. If anything - more funding should be allocated in this area. Here again, we have to look at "root causes." Is it poor teachers, lack of family guidance, incompetent administrations? All factors have to be examined and action taken to find solutions. Cutting funds without analyis is not the route to take.
The GOP wants to virtually eliminate oversight of the financial sectors. For those of us who lost large sums of money due to the greed of Wall Street and the brokerage firms, more oversight would be welcome. While it would be nice if the financial sector policed themselves -- there is too much greed and dishonesty for that to happen.
These are only a few of the problems. They even extend to our foreign policy (both parties) that fail to look at the consequences of whom we support.

March 02 2011 at 8:12 AM Report abuse rate up rate down Reply
mperrydusty

Wow! Who does support cancer killing millions annually? I don't. I saw what it did to my mother.
But here's the thing. We, the USA, are broke. We're broke at the federal, state, and local levels.
Everything must be questioned. Everything. From 12 carrier fleets, to unemployment for 99 weeks to free school lunches being eaten by kids with I-Phones. If we don't, the consequences will be enormous. This is about preserving a viable future for your children and grandchildren. I already got mine. Of course I'd also like extra with social security and a million dollar operation paid for by medicare. But if you lack the will to make the cuts now, your children will pay for it with a dimmer future. Ask any honest financial planner if he really thinks the next generation will have it better than their parents. That will be your answer.

March 02 2011 at 7:58 AM Report abuse +7 rate up rate down Reply
1 reply to mperrydusty's comment
charles p

Sorry Mperrydusty, but your argument doesn't hold water. I agree that we need to make judicious cuts and reallocation of the public's money although even that seems to be governed more by politics than need. But where I really disagree with you the USA about being broke. In fact, there are scads of money out there, its just that we used government over the past 31 years to redistribute it to the top 5 per cent and have not required them to reinvest it here in the US. Tax rates are at the lowest on this class of people than at any time since before the Depression. Arguably, the deregulation, defense spending, bailouts, foriegn and tax breaks have gone disproportionately to them. I see no problem with raising the top rate to 45% on income, 50% on capital gains and 65% on non-earned income (inheritances) over 1.5 million dollars. These are not out of line with other capitalist based countries in the world. I also think we need to take an ax to the defense department, cut its budget by 30% and stop handing out these luxury retirement benefits to members of the armed forces. (Like retiring at 47 with an income of $65,000!). I know the GOP would hate this because it strikes at their most important base for raising election funds but is it really any different than going after the Union base of the Democrats?) Finally, I think we need drastic limits on the amounts of money that can be contributed and spent on elections, the extreme concentration of wealth and media control into just a few hands has resulted in a poorly informed or totally misinformed electorate. Not requiring the wealthy to accept their responsibility as citizens has led to this crises, requiring them to share in the sacrifices is fair.

March 02 2011 at 3:46 PM Report abuse rate up rate down Reply
activebz

I want Walter Shapiro, other commentators, and VOTERS to think or write in EVERY ARTICLE of this kind, 'and yet we gave the tope two percent (billionaires) a 700,000 DOLLAR tax break extension'. Or, we gave the banks who caused the fiscal crisis (and none went to jail) TRILLIONS of dollars to keep operating, and yet they are not lending (and there is no accountability, and only some of it came back to tax payers.

I strongly wish there to be a 'CONNECT THE DOTS ' awareness (ACTION-ORIENTED OUTRAGE) built up -- about where the money went -- that is behind these FOOLISH cuts that is and will go on creating unnecessary suffering and further American decline. Never mind the political posturing. I, like others, who love this country and the democracy we once had to a far greater extent KNOW that the USA has turned to into a PLUTOCRACY (government run for the benefit of the rich) . Win the future? The future is and will continue to move OUT of the this country.
It IS the economy, stupid, and we have been taken to the cleaners, there is 'something wrong with Kansas', meaning (too many vote against their interests as citizens and taxpayers --& swallow this Republican driven, spineless Democratic line -- be it anti-science, anit-working people & middle class quality of live, coupled with a sleeping press that does not connect the dots and in becoming propaganda, entertainment drivel, or given a President who's slogan 'change we can believe in' a pass. But then the Press is increasingly consolidated and owned by the like of Murdoch and the billionaires behind much of this anyway.

I read this column with appreciation. Please remember it is the duty of a Free Press to connect the dots, starting with the fact and getting to causes, not just consequences that are skin deep.

March 02 2011 at 6:46 AM Report abuse +2 rate up rate down Reply
1 reply to activebz's comment
MY LORD

The top 2 % are not JUST Billionaires, They are households make over 260K a year, and up. We pay more than our share now of taxes. Blames the banking fiasco on ACORN and democrats like Frank Dodd and Waters. If you connect the DOTS the money went to crooked politicans, mostly Democrats

March 02 2011 at 10:10 AM Report abuse +2 rate up rate down Reply
mjmecon

We as a nation are in trouble. Here is the problem, this man is wrong yet everyone thinks he is right. My wife is is an MD, Ph.D use to work at NIH, great place to play computer games. She spends almost all her time writing grants and barely has time for research. Grants when they are politically funded of course can't always go to the best percieved idea(then how would congressmen crow about bringing home research money) so they go all over the place, depending on political pull. If it were in the private sector, it would go to the best idea, unless of course you could lobby Congress for funds, which of course you can. You see the Lebertarians are right, but no one sees it because we think we have tried free markets, but free markets mean you cannot lobby for special advantage, we have never tried it, if we every did this country would be a paradise.

March 01 2011 at 8:28 PM Report abuse +2 rate up rate down Reply
Bull

Sadly, Repubs don't even shock me anymore with their greed, ignorance and malice. Let's cut off cancer research and WIC but give more and more tax cuts to uber billioniares who haven't created a single job or even tried to stimulate the economy. Great. Thanks teabaggers.

March 01 2011 at 7:04 PM Report abuse -4 rate up rate down Reply
3 replies to Bull's comment
mrd39fr

A book was written back in 1910 by Wallace D. Wattles, The Science Of Getting Rich. In it he mentions a person i believe he was the mayor or toledo Ohio, then," Beware of the competitive mind! No better statement of the principle of creative action can be formulated than the favorite declaration of the
late " Golden Rule" Jones Of Toledo:, "What I want for myself, I want for everybody. We have all lost site of careing, money drives everything, the real cancer is the allowing of lobbyist running our country, special interest group. Not since the 1950's has there been a cure for anything, polio comes to mind..We better grab our boot straps the ride over the next few years will be the roughest times ever... The bankers that were allowed to steal our homes, land, and send our jobs over seas, will be luckey to feed ourself....Let the real research people be able to use the cancer treatments for the good of all men,not just corporate greed.. Remember not so long ago when 10% was a good profit. Where is our leadership in this country......

March 01 2011 at 4:11 PM Report abuse +16 rate up rate down Reply
bthered

The Republican Party is owned and controled by a handful of very, very Rich People. If your voting for Republicans lets hope your rich.

March 01 2011 at 2:04 PM Report abuse +3 rate up rate down Reply

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