Saturday, September 20, 2014

The $30 Billion Ice Bucket Challenge

This past summer 3 million people spontaneously dumped buckets of ice water on their heads and/or donated their hard earned cash to the ALS Association to support research.  What on earth would provoke this synchronized advent of charity, without warning?  The answer to that question is far beyond the scope of this blog and lies somewhere wrapped up in the mysteries of human behavior, perhaps beyond human explanation.  But it certainly had a lot to do with social media. 

And it’s a good thing. 

Although the origins of the ice bucket challenge phenomenon are mysterious, the outcome so far has been an additional $100 million dollars raised to fund efforts to counter Lou Gehrig’s disease (ALS).  Faith in humanity?  Restored.

Mysteries aside, I was really excited to see so many people taking an interest in supporting medical research, and recognizing it as a valuable cause worthy of uniting us.  ALS is a terrible disease without a cure, and those who are trying to understand it and treat it need all the help they can get.  But, it is only one of many problems that medical researchers are working on, and incidentally funding for research must be spread around far and wide.

So, where does funding for research on diseases like Lou Gehrig’s come from when people aren’t turning buckets of ice water upon themselves and posting the video on youtube?  Well, in the United States most of the money comes from the National Institutes of Health (NIH), which is part of the Department of Health and Human Services.  The NIH is actually the “largest source of funding for medical research in the world”. 

And where does the NIH get the money from?  It comes from YOU (assuming you are a tax-paying U.S. citizen, of course). 

This year, the NIH was given a budget of $30,151,000,000 (that’s 30 bilion).  For 2015, NIH Director Francis Collins has requested from congress a 0.7% increase (the current inflation rate is 1.7%, FYI).  To put this in perspective, the budget for the Department of Defense in 2014 was 526 billion, and the budget for the Department of Labor was 12 billion. 

30 billion dollars is a lot of lettuce – for one person.  But for the NIH, this money gets sliced and diced many ways.  At least 237 ways, to be precise.  That is the number of disease research categories where the money is distributed.  You can see the full list here, but these are the most salient targets of funding: 

1.       Clinical Research: $10,928,000,000 (10.9 billion)
2.       Genetics: $7,330,000,000 (7.3 billion)
3.       Prevention: $6,853,000,000 (6.8 billion)
4.       Biotechnology: $5,845,000,000 (5.8 billion)
5.       Neurosciences: $5,477,000,000 (5.4 billion)
6.       Cancer: $5,418,000,000 (5.4 billion)
7.       Infectious Diseases: $5,015,000,000 (5.0 billion)

And somewhere much further down the list, you would find Lou Gehrig’s Disease (ALS), which received a $40,000,000 (40 million) slice of the pie.  Note that many of these categories overlap, so the sum is well above 30 billion.

The actual ‘research’ is for the most part done by thousands of grad students and post-docs who are holed up in labs with pipettes away at universities and research institutes across the country.  These are people who work hard, many are passionate about what they do, and most are obviously not in it for the money.

But over the years, federal spending on medical research has not increased at the same rate as inflation.  This makes it harder and harder to be a research scientist in the United States.

As a scientist, in order to receive any of this funding in the form of a grant, you must first write up a long and detailed grant proposal that explains exactly how much you need, how it will be spent, and how long you will need it for.  After going through a very competitive review process, only about 17% of the proposals will currently get the stamp of approval from the NIH.  The other 83% go in the rejected bin. 

It was not always so competitive.  The success rate was once as high as 45% in the mid-1970’s, and even 30% at the turn of the millennium.  This is illustrated in the chart here below, that I made from data posted on the NIH website.

The Center for American Progress has produced two graphical illustrations of the decline of NIH funding: one as a percentage of GDP, and one with values adjusted for inflation.  You can see them here.

Diminishing budget or not, research and development is by nature not a financially profitable venture.  But perhaps the payoff can be measured in terms of life expectancy rather than dollars.  Consider that the average American lifespan from birth is currently about 78.5 years, an increase of 8.4 years from 1966 in spite of the introduction of HIV, the increasing ubiquity of cancer, and the rise of fast food during the meantime.

In conclusion, the most important thing to understand from all of this is that medical research is important, it is difficult to do, it is expensive, it is not usually financially profitable, but it is all for your benefit.  The research that results from it will hopefully someday find its way back to you down the road when you need it.  It is a tremendous resource to us, one that perhaps we take for granted too often.

And so next time you file your federal income taxes, feel free to at least splash a few drops of cold water on your face.  Our 30 billion dollar ice bucket challenge has collectively been accepted.