This time, it's personal

The Prez has proposed a slight increase in funding for the National Institutes of Health in his new budget, even as he wants to trash low income heating assistance and community service block grants. Winning the future and all that, even if we have to freeze a few folks to death in the present.

Still, from my personal point of view as a greedy sociopath -- which I believe is what it takes these days to be fashionable -- Mr. Obama has his priorities right. I depend on NIH funding but I don't get heating assistance. In fact the increase in the president's budget, after inflation, would leave NIH basically level funded and about where it was in 2000. This is despite a much larger economy than we had back then, obviously. (If you aren't feeling richer it's because the larger economy in part reflects a larger population, and the rest of the growth has gone to the super wealthy and not to you, unless the Koch's happen to be reading.)

The Republicans, however, don't even want to level-fund NIH. They want to cut it, back to the nominal dollars they got in 2008. Right now, in the face of uncertainty and with available dollars flat-funded by the continuing resolution under which the federal government is operating -- at least for this week -- NIH is not paying off any proposals that got a score from their scientific review groups above the 10th percentile. (This is scuttlebutt -- I don't know if there's an official source for it.) Due to the complexities of the NIH review process, that means that fewer than 10% of proposals are being funded. You only get to resubmit once so ultimately, fewer than 20% of all proposals to NIH will get paid off.

This has a lot of implications for the public, obviously. It means that health research will slow way down. And this is a bad time for that to happen, for several reasons. One of the most important is that we've gotten to the point where the health care system has a huge backlog of poorly absorbed biomedical knowledge. NIH has been putting major emphasis on Clinical and Translational Sciences, which means trying to get the latest knowledge and technology to actually be incorporated into clinical practice effectively. We have yet to reap the harvest from the explosion of scientific knowledge in recent decades, so that is low hanging fruit for the public good.

A related emphasis is social and behavioral science. We know that doctors don't do a lot of what they ought to be doing to practice evidence based medicine; and we know that folks don't do a lot of what they could be doing to keep themselves healthier. We can get a much bigger bang for the buck by just figuring out how to get people to stop being such screwups than by just about any other investment. Again, low hanging fruit for the public good.

And just as we're getting out in the field with the wagons, they want to puncture the tires. In the name of freedom, apparently.

Okay, here's the thing. I do translational clinical social science. That's what I do for a living. I have a proposal in right now which will be funded if Obama gets his way and will not be funded if the Republicans get theirs. I hope I can somehow keep my job and keep my program of research going either way, but in the latter case it will be a rough go. So yeah, maybe I'm not a credible advocate because of my personal stake -- but then again, neither are any of the conservative pundits, they're all rich, or the plutocrats who pay for most of the politicking and political propaganda in this country.

I like to think I do what I do because it's the right thing to do, as well as a job. But lots of people like me will be doing something else in a couple of years if the Republicans get their way. Lots of newly minted Ph.D.s will never get jobs, and post docs will never get faculty appointments. Labs and whole research institutes will collapse. We'll lose a huge investment in people and institutions, forever, and everything it might have given us one day in human knowledge and human welfare.

So do me a favor: call or write your senators and representatives, and tell them to support the National Institutes of Health.