The 2018 budget request from the Trump administration has raised the ire of the medical and science community because it calls for massive cuts on spending for scientific and medical research, among other things.
Funding for cancer research would be hit hard. The overall National Institutes of Health (NIH) budget would be slashed from $31.8 billion to $26 billion, and the National Cancer Institute (NCI) would be hit with a $1 billion cut compared to its 2017 budget.
In addition, Medicaid funding would be cut by more than $600 billion during the next 10 years, which would leave many of the poorest Americans, including children, the elderly, and the disabled, without any health insurance.
The backlash from major cancer organizations has been swift and unanimous in strongly opposing the proposed cuts.
"Such extreme reductions to programs that are critical to research will fundamentally damage our nation's progress in treating patients and will irreversibly harm our nation's already fragile biomedical research infrastructure," commented the president of the American Society of Clinical Oncology (ASCO), Daniel F. Hayes, MD.
The outlook for cancer patients has vastly improved during the past 50 years, largely owing to federally funded research, he pointed out.
In addition, the NIH has funded basic research that provides "keys to the genesis and biology of cancers; risky, pioneering clinical studies in rare-disease patient populations; and large-scale prevention studies that private industry has little incentive to pursue."
Federal research funding also helps fuel economic strength and scientific leadership in this country, Dr Hayes explained, which has in turn supported 400,000 jobs and contributes about $60 billion in economic activity annually.
"Gutting critical federal support at this time will jeopardize Americans' health and our country's scientific leadership and economic growth," he says.
"Entire Research Programs Could Shut Down"
The American Society for Radiation Oncology (ASTRO) has also weighed in. It pointed out how the cuts to the NIH and the NCI would be achieved largely by capping overhead costs associated with federal research funding at 10%, which is in contrast to the approximately 50% to 60% that the institutions currently receive to defray administrative costs.
"Implementing an unrealistic cap on these administrative dollars would result in fewer jobs for researchers, especially for early career scientists, and less support for clinical trials," said ASTRO in a statement. "More dangerously, it could cause entire research programs to shut down."
The cuts to Medicaid would limit access to healthcare coverage, and "multiple studies have demonstrated a link between inadequate health insurance and delayed cancer diagnosis and treatment, ultimately resulting in higher mortality rates," ASTRO said.
Voters Want Increased NIH Funding, Not Cuts
The American Cancer Society reiterated the opposition expressed by ASCO and ASTRO, and also noted that these cuts would "completely undermine the increases for research secured in the bipartisan 21st Century Cures Act meant to accelerate progress against diseases like cancer."
Chris Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN), emphasized in a statement that most voters want NIH funding to be increased, not cut. "According to a poll released Monday, an overwhelming 90% of voters believe federal funding for medical research is 'very' or 'extremely' important, and 75% want Congress to significantly increase NIH funding. More than two thirds oppose the cuts as proposed in the president's previously released 'skinny' budget."
Funding for the US Centers for Disease Control and Prevention (CDC) is also on the chopping block, and Hansen noted that this will also l have an impact on cancer prevention efforts. "Cutting the CDC chronic disease budget by nearly 20% threatens to substantially weaken vital tobacco prevention and cessation programs as well as important efforts to address nutrition, physical activity, and obesity — all significant cancer risk factors."
Affect Basic Science Funding
The president of the American Society of Hematology (ASH), Kenneth C. Anderson, MD, noted that the planned cuts to the NIH equates to cutting "one in every five dollars to this vital agency." These cuts would dramatically reduce the NIH's ability to fund basic science research in universities and laboratories across the United States, he said.
"Not only does every dollar invested by NIH yield an estimated $8.38 in economic growth, but it also funds the research that leads to cures and therapies that keep Americans alive and healthy," he said.
The dramatic cutbacks to Medicaid will also affect patients with blood disorders such as sickle cell disease, Dr Anderson explained. He pointed out that Medicaid covers approximately 30% of the community of patients with bleeding disorders, which includes patients with diseases such as hemophilia and von Willebrand disease.
Misguided Budget Proposals
Perhaps one of the sharpest rebukes came from Friends of Cancer Research, an advocacy organization based in Washington DC.
"At best, the proposed budget suggests that the White House doesn't understand how the NIH and the FDA function. At worst, it suggests a disregard for the millions of patients who are desperate for the scientific innovations, lifesaving therapies, and safeguards that emerge from these agencies," writes the founder and chair of the organization, Ellen V. Sigal, PhD.
Dr Sigal emphasized that the budget also proposes a reduction in funding to the FDA of nearly $1 billion, and the budget contemplates "propping up the FDA by increasing user fees from pharmaceutical companies."
However, the private sector is already supporting a significant portion of the FDA's drug review. "It's surprising that the business-friendly Trump administration would expect private companies to shoulder the burden of critical public health programs, such as monitoring the safety of drug supply chains, managing drug shortages, and overseeing compounding facilities," said Dr Sigal. "It seems to show a lack of knowledge on the part of the administration on the appropriate use of user fees and the scope of the FDA's work in ensuring the safety of Americans."
Referring to the proposed budget as "misguided," Dr Sigal emphasized that, combined with the Trump administration's "unjustified and foolish hiring freeze," the understaffing that is already hindering the FDA's ability to do its job will worsen. "With FDA vacancies already north of 500, this budget goes in the wrong direction, especially for an agency that is so vital to ensuring that the American public has access to effective and safe treatments," she says.