NIH funding restricts neurological research

Abstract

In March 2007, nine leading US universities and research institutions published a report that expresses their concerns over governmental funding for the National Institutes of Health (NIH). Between 1998 and 2003 medical research in the USA received a welcome boost when the NIH had its budget doubled. The confidence generated as a result of this investment enabled substantial development in terms of new facilities, projects, and discoveries. Since 2003, however, NIH funding has increased only marginally and once inflation is taken into account purchasing power has decreased by 8%. This situation is mirrored in the two institutes administering funds specifically for neurological research, the National Institute of Neurological Disorders and Stroke and the National Institute on Aging. For example, NINDS funding increased by only 0·5% in 2006 and by 0·07% in 2007. Major discoveries in neuroscience have been made as a direct consequence of the halcyon period of funding, and further findings are at risk of not being translated into patient benefits. NIH funding has contributed substantially to the elucidation of mechanisms underlying the formation of amyloid plaques, paving the way to clinical trials testing drugs such as tramiprosate, which are designed to inhibit the formation of these plaques in Alzheimer's disease. Although potentially exciting, it remains important to explore alternative therapeutic avenues. A new report from the Alzheimer's Association suggests that the prevalence of the disease in the USA is 10% more than previously thought. Over 5 million people are estimated to have the disorder, so continued funding is vital to sustain the efforts to find a treatment. In spinal-cord injury research, NIH funding has enabled important advances into our understanding of myelin-associated inhibitors, such as Nogo, and other mechanisms that block regeneration of spinal-cord nerves. Current work on targeting these mechanisms may eventually lead to spinal-cord repair. An estimated quarter of a million patients in the USA live with spinal-cord injuries. Cessation of neurological investment now can at best be considered a short-sighted policy. There are many effects of flat funding. Laboratories and projects are downsized and frozen as more than eight out of ten grant applications are unfunded. Moreover, US scientists are being tempted to move abroad by the promise of high investment in countries in Asia and Europe. Perhaps more insidiously, medical research may be seen as over-competitive and a less appealing option for those considering future careers. It is also possible that with fewer grant applications being funded, prioritisation of popular research areas will occur to the detriment of those perceived as less attractive. The report suggests that researchers are abandoning innovative work because projects perceived as risky are already less likely to be funded. Although there is no suggestion that the institutes are deliberately distributing funds unevenly, it will surely become more appealing for researchers to submit applications for research on disorders they know are of high popularity. As an example of uneven fund distribution, in 2004—at the peak of the US funding boost—it was suggested that stroke was relatively underfunded in both the USA and Europe compared with other neurological disorders and general medical research. Several reasons underlie the funding policies. First, vital resources are being reallocated for other issues, such as the war in Iraq. In addition, it has been suggested that there is a feeling in the government that the previous large investment renders further increases unnecessary. Often, neurological conditions involve long-term rehabilitation after an acute event or a degenerative condition over many years. It can be difficult to present a definitive result to a funding body proving the successful outcome of a research project when decades of follow-up may be needed. Moreover, the current high profile of several charitable foundations may be promoting the idea that government funding is less necessary. Although these sponsors are useful, they cannot begin to approach the funding that the NIH administers. It is imperative that a brief period of investment in the NIH is not regarded as a long-term fix for medical research funding. Continued, sustained investment is mandatory if the USA is to maintain its place in the international community of biomedical research. It is also important that basic science discoveries are translated into real patient benefits both to combat disease and to demonstrate to funding bodies the effectiveness of project support. Neurological conditions are increasing in prevalence, and efforts are needed that are proportional to the effect of the diseases themselves.