Janis L. Abkowitz, MD
It is an absolute honor to write as president of ASH, and I am especially honored to be your leader at this complex time when our challenges as hematology clinicians and researchers are huge, but when the opportunities are equally compelling.
I am writing this first column on my plane home from our December meeting, excited by what we just heard. Genomic information is well poised to provide new paradigms for diagnosing hematologic disorders, risk stratification, and treatment. Model systems from primary cell cultures to iPS cells to zebrafish to mice are available as tools for discovery. Small molecules and engineered autologous cells have huge therapeutic potential for our patients. I scribbled notes to myself with ideas for new studies and new collaborations. Our science is strong, our Society is strong, and we value each other as colleagues and friends. This is an exciting time to be a hematologist.
But this is also a challenging time, as the funding of hematologic research and the funding of research more broadly are threatened. In a survey of 1,040 presenters of abstracts at our meeting, 63 percent of those from the United States reported that their work was supported by National Institutes of Health (NIH) monies. Should sequestration occur, NIH faces an estimated 8.4 percent budget decrease, and given its ongoing intramural and extramural commitments, this could translate into an estimated 2,400 fewer grants and a payline well below the current low level of 7 to 13 percent. This means that far less than 7 to 13 percent of the R01 (investigator-initiated research) applications deemed scientifically excellent by review panels would be funded. If sequestration is averted, but an alternative deficit reduction plan in which science is insufficiently appreciated is implemented, equal or potentially more severe cuts are possible.
The NIH funds ideas, and ideas develop in a nonlinear fashion. The path from a hypothesis to a product is often too long, too circuitous, or too risky for pharmaceutical company investment. By funding testable ideas, NIH assures that innovation drives both scientific discovery and the resulting economic enterprise. Similarly, NIH funds research on rare but devastating disorders and on health disparities. The NIH also funds clinical trials and correlative studies that can significantly advance patient care without the potential of influence from financial incentive. Fifty-two percent of international presenters at our annual meeting said that they referenced an NIH-funded study in their own research, documenting the wide reach of NIH support.
What is ASH doing? We opted to fight and have taken a multifaceted approach. We established a new bridge grant program for hematology investigators whose R01 applications are meritorious but not funded. We will invest in our future by helping to maintain hematology research and our skilled and innovative workforce through this economically difficult time. We launched the ASH Foundation, naming research an initial top priority. We increased our advocacy efforts and are leading or joining with other nonprofit organizations to support a balanced approach to deficit reduction that preserves the NIH along with other non-defense discretionary programs.
What should you do? Although we as hematology clinicians and researchers understand the process of science – how laboratory discoveries can help our patients and how observations in patients can direct research – our legislators in Washington, DC, may not. Share your joy in seeing sick patients get better as a direct result of a hematologic discovery. Share your excitement about a new concept and its health-care or economic potential. The number of contacts by constituents is counted when congressional offices consider policy decisions. Visit the ASH Advocacy Center. This site lists many specific ways that you, your colleagues, and your patients can help. Together our voices are powerful.
By the time you read this column, sequestration may be resolved, and NIH support may be either more precarious or conserved in next year’s federal budget. Yet our advocacy should not stop. A budget is for one year, but ASH’s goal is the long-term sustainability of NIH-funded research. The ASH website is continually updated to reflect the most current political and economic circumstances. I urge you to “Fight 4 Hematology.”
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