Slowdown on Research

It may sound dramatic to say so, but today, lights are going out in laboratories in many parts of America.

Dr. Arthur Kornberg, Nobel laureate and Stanford University professor of biochemistry, who made that gloomy statement in March before the House Subcommittee on Public Health and Environment, was not exaggerating. In its proposed budget for the fiscal year beginning July 1, the Nixon Administration has drastically cut federal support for research projects, medical schools and hospitals. As a result, many doctors and scientists fear that American medical research--long pre-eminent in the world--could be severely hobbled and perhaps set back by as much as a decade.

If the budget proposals are approved, the ax will fall on a wide range of medical institutions and programs. Two years ago, for example, the National Institute of General Medical Sciences, which supports a variety of projects in the field of genetics, had a budget of $28.3 million for new research grants; next year it will get $5,000,000. General research support grants, administered by the National Institutes of Health's Division of Research Resources, have been cut from $55.2 million to $17 million. Research fellowships and training grants, essential to the training of medical researchers and instructors, are being phased out completely. Although funds for training totaled $185.5 million in fiscal 1972, the Administration is asking for only $125.9 million next year, all of it to honor commitments already made. Once those now receiving fellowships complete their courses, the program will end.

On the face of it, the funds for basic research seem to have held their own in the Administration's new budget. In 1972 this "investigator-initiated" research got $564.3 million; next year the amount proposed will actually increase slightly--to $582.8 million. But many doctors feel that the figures mask an alarming change in direction that will have a long-range effect. The Administration is actually budgeting $460.6 million for continued funding of research already under way; the $122.2 million that is left for new research projects is $85 million less than in 1972. As a result of that reduction, the National Cancer Institute's allocation for new research is being chopped from $32 million to $24 million.

The alarm has also been sounded at the nation's medical schools, which count on the Government for almost 50% of their operating budgets; in the new budget, they will get 15% less money next fiscal year than this, and 25% less than they had hoped for. The University of Washington's medical school, for one, stands to lose at least $7,000,000 in federal grants. As a result, it is cutting back on its training of nurses and pharmacists, and may lose 100 faculty members. The University of Pennsylvania School of Medicine plans to increase tuition by 6%, even though more than half of its student body now needs financial assistance to get through school. A study by the Association of American Medical Colleges predicts that U.S. medical schools may have to discharge as many as 1,400 faculty members unless additional funds become available.

Cuts in research funds will also have a direct effect on patient care in many communities. The University of Michigan, which will lose $700,000 in general research grants, is terminating a research project that has provided drug treatment for patients with cancer of the colon. When the reductions are fully effective, Children's Hospital Medical Center in Boston will lose half of its trainees in pediatric cardiology; they are primarily supported by the National Heart and Lung Institute. "We can't accept fewer patients," says the program's director Dr. Alexander Nadas, "so the quality of care must be affected."

Nadas is even more concerned about the long-range effect of the budget. "The funding cuts will make a major impact on teaching, on care and on research," he says. "It will be years before we can recoup. Once they turn the faucet off, you cannot easily turn it on again, because there will be nothing to come out."

Cost Effectiveness. Despite the obvious blow to medical research and care, the Administration has been stoutly defending its budget slashes. Says Dr. John Zapp, Deputy Assistant Secretary of Health, Education and Welfare: "We are convinced that direct support of the training of biomedical scientists for careers in research is at this time an unnecessary and unproductive expenditure of public funds." As the Administration sees it, the need for large numbers of research scientists has passed, and training too many more could lead to an oversupply. The Administration also believes that scarce federal funds should be used to apply knowledge that is already in hand, and that those who seek careers in research should pay for their own training.

Doctors and medical researchers are generally cynical about the cutbacks. Some see them as a form of revenge by President Nixon on a scientific community that has largely opposed him politically. A handful attribute the new budget to simple shortsightedness. "Those guys in the White House must think they're never going to get sick," says a Manhattan virologist. But most medical men blame the slashes on the cost-accounting mentality that now seems to prevail at HEW. Says Dr. James Watson, who won the Nobel Prize for deciphering the structure of the DNA molecule: "The thought that 'directed' and 'planned' research should get us there faster apparently seems more and more obvious to the legal accountant bosses of HEW, schooled in the virtues of corporate planning sessions that have produced unassessable successes like the Band-Aid and the Mustang."

In anticipation of the cutbacks, some medical schools are appealing to state legislatures for funds--thus far without notable success. Others are seeking private support for research. Dr. Robert Felix, dean of the St. Louis University School of Medicine, has devoted himself to hustling funds full time since his school lost about $1,000,000 of its $11 million budget. "Now I know how a prostitute feels," he says. "But there's no way around it."

There still may be hope for Felix and his fellow deans. Congress has already passed an omnibus health bill restoring five programs--including hospital construction, regional medical programs, and public health and allied health training--that the Administration had tried to kill. Moreover, the measure passed by such an overwhelming margin (372 to 1 in the House; 72 to 19 in the Senate) that President Nixon last week quietly signed it into law. Now Congress is trying to salvage other health measures. The House, under the leadership of Representative Paul Rogers of Florida, has passed a $415 million training and fellowship bill that is also expected to win Senate approval. The House Appropriations Committee is attempting to restore all NIH items to or above the 1972 funding level and re-establish the old ratio between new and ongoing research grants. If Congress succeeds in saving these programs, it can still prevent both the lights in the laboratories and the luster of American medicine from being dimmed.

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