The Budget Cut We Can't Afford

The National Heart Institute was created in 1948 by President Harry Truman and was funded by Congress in 1951 with an authorization of $16 million dollars. It subsequently became part of the National Institutes of Health (NIH) and was later integrated into the National Heart, Lung, and Blood Institute (NHLBI) in 1972. Since its inception, it has experienced considerable growth. In 2006, its budget was slightly less than $3 billion dollars, with approximately $2.5 billion going to research and most of the remainder to training grants. Of this total, about $1.6 billion supports heart and vascular disease research. The expenditure for medical research by Congress at the NIH and the NHLBI far exceeds that of any other nation and in a large part explains the leadership that the United States has shown in the last half century.

Much of the research carried out in our medical schools and research institutions depends upon NIH support. During the later part of the 20th century, the funding increased greatly. Between 1998 and 2003, support for the NHLBI doubled, resulting in a number of important initiatives including the human genome project, development of a variety of new diagnostic techniques directed toward our understanding of pharmacogenetics, and the development of personalized medical therapeutics. Since then, however, there has been a budgetary plateau resulting in little or no increase in federal funding for medical research in general and cardiac research in particular.

This plateau has had profound effects on the ability of the NIH to respond to new research requests and to continue to support ongoing research. The current budget proposed by the president for the NIH and the NHLBI reflects a continuation of this plateau research support. When taken in the context of continued inflation during the last 5 years, it represents a significant actual decrease in funding. There has been no lack of research proposals and requests, however. Although there has been a continuing increase in research applications (more than 3,500 in 2007), the number of approved research projects has decreased from a high of more than 35% in 2001 to approximately 27% in 2005. The “pay line” for research projects, which reflects the percentage of approved grants that are actually funded, which was as high as 35% in 2001, fell to less than 20% in 2005 and has continued to fall since then. This year, it is projected to be 14% for previous investigators and 19% for first-time investigators. The most profound effect will be on new investigators. Although given a slight preference over continuing grant requests, they will be facing even greater difficulty in obtaining support. This is certain to discourage young physicians from continuing research careers. The failure to rejuvenate our investigator pool will have far-ranging effects on future research productivity.

Over the last half century, much of industry-supported research has been built on research emanating from the basic laboratories in medical schools and research institutions largely supported by the NIH. This basic research has been the platform upon which new drugs and devices have been created. The knowledge gained from this research and its translation to the bedside has had a profound effect on the mortality of cardiac patients both in this country and around the world.

These budgetary issues may appear to have little relevance to the practicing cardiologists who are busy trying to balance their own books, but they represent important issues facing cardiology in the future. We have benefited immensely from the research productivity during the last half century. It has provided the impetus and support of much of what we do in our day-to-day clinical activities and has been translated into the standard of everyday care of our patients. The impact that this has had on our patients' health cannot be underestimated. It is essential that we continue to maintain our research efforts into the future. The underfunding of cardiovascular research at the national level represents a major barrier to the continuation of our success and places future generations at risk of experiencing heart disease.

The National Heart Institute was created in 1948 by President Harry Truman and was funded by Congress in 1951 with an authorization of $16 million dollars. It subsequently became part of the National Institutes of Health (NIH) and was later integrated into the National Heart, Lung, and Blood Institute (NHLBI) in 1972. Since its inception, it has experienced considerable growth. In 2006, its budget was slightly less than $3 billion dollars, with approximately $2.5 billion going to research and most of the remainder to training grants. Of this total, about $1.6 billion supports heart and vascular disease research. The expenditure for medical research by Congress at the NIH and the NHLBI far exceeds that of any other nation and in a large part explains the leadership that the United States has shown in the last half century.

Much of the research carried out in our medical schools and research institutions depends upon NIH support. During the later part of the 20th century, the funding increased greatly. Between 1998 and 2003, support for the NHLBI doubled, resulting in a number of important initiatives including the human genome project, development of a variety of new diagnostic techniques directed toward our understanding of pharmacogenetics, and the development of personalized medical therapeutics. Since then, however, there has been a budgetary plateau resulting in little or no increase in federal funding for medical research in general and cardiac research in particular.

This plateau has had profound effects on the ability of the NIH to respond to new research requests and to continue to support ongoing research. The current budget proposed by the president for the NIH and the NHLBI reflects a continuation of this plateau research support. When taken in the context of continued inflation during the last 5 years, it represents a significant actual decrease in funding. There has been no lack of research proposals and requests, however. Although there has been a continuing increase in research applications (more than 3,500 in 2007), the number of approved research projects has decreased from a high of more than 35% in 2001 to approximately 27% in 2005. The “pay line” for research projects, which reflects the percentage of approved grants that are actually funded, which was as high as 35% in 2001, fell to less than 20% in 2005 and has continued to fall since then. This year, it is projected to be 14% for previous investigators and 19% for first-time investigators. The most profound effect will be on new investigators. Although given a slight preference over continuing grant requests, they will be facing even greater difficulty in obtaining support. This is certain to discourage young physicians from continuing research careers. The failure to rejuvenate our investigator pool will have far-ranging effects on future research productivity.

Over the last half century, much of industry-supported research has been built on research emanating from the basic laboratories in medical schools and research institutions largely supported by the NIH. This basic research has been the platform upon which new drugs and devices have been created. The knowledge gained from this research and its translation to the bedside has had a profound effect on the mortality of cardiac patients both in this country and around the world.

These budgetary issues may appear to have little relevance to the practicing cardiologists who are busy trying to balance their own books, but they represent important issues facing cardiology in the future. We have benefited immensely from the research productivity during the last half century. It has provided the impetus and support of much of what we do in our day-to-day clinical activities and has been translated into the standard of everyday care of our patients. The impact that this has had on our patients' health cannot be underestimated. It is essential that we continue to maintain our research efforts into the future. The underfunding of cardiovascular research at the national level represents a major barrier to the continuation of our success and places future generations at risk of experiencing heart disease.

The National Heart Institute was created in 1948 by President Harry Truman and was funded by Congress in 1951 with an authorization of $16 million dollars. It subsequently became part of the National Institutes of Health (NIH) and was later integrated into the National Heart, Lung, and Blood Institute (NHLBI) in 1972. Since its inception, it has experienced considerable growth. In 2006, its budget was slightly less than $3 billion dollars, with approximately $2.5 billion going to research and most of the remainder to training grants. Of this total, about $1.6 billion supports heart and vascular disease research. The expenditure for medical research by Congress at the NIH and the NHLBI far exceeds that of any other nation and in a large part explains the leadership that the United States has shown in the last half century.

Much of the research carried out in our medical schools and research institutions depends upon NIH support. During the later part of the 20th century, the funding increased greatly. Between 1998 and 2003, support for the NHLBI doubled, resulting in a number of important initiatives including the human genome project, development of a variety of new diagnostic techniques directed toward our understanding of pharmacogenetics, and the development of personalized medical therapeutics. Since then, however, there has been a budgetary plateau resulting in little or no increase in federal funding for medical research in general and cardiac research in particular.

This plateau has had profound effects on the ability of the NIH to respond to new research requests and to continue to support ongoing research. The current budget proposed by the president for the NIH and the NHLBI reflects a continuation of this plateau research support. When taken in the context of continued inflation during the last 5 years, it represents a significant actual decrease in funding. There has been no lack of research proposals and requests, however. Although there has been a continuing increase in research applications (more than 3,500 in 2007), the number of approved research projects has decreased from a high of more than 35% in 2001 to approximately 27% in 2005. The “pay line” for research projects, which reflects the percentage of approved grants that are actually funded, which was as high as 35% in 2001, fell to less than 20% in 2005 and has continued to fall since then. This year, it is projected to be 14% for previous investigators and 19% for first-time investigators. The most profound effect will be on new investigators. Although given a slight preference over continuing grant requests, they will be facing even greater difficulty in obtaining support. This is certain to discourage young physicians from continuing research careers. The failure to rejuvenate our investigator pool will have far-ranging effects on future research productivity.

Over the last half century, much of industry-supported research has been built on research emanating from the basic laboratories in medical schools and research institutions largely supported by the NIH. This basic research has been the platform upon which new drugs and devices have been created. The knowledge gained from this research and its translation to the bedside has had a profound effect on the mortality of cardiac patients both in this country and around the world.

These budgetary issues may appear to have little relevance to the practicing cardiologists who are busy trying to balance their own books, but they represent important issues facing cardiology in the future. We have benefited immensely from the research productivity during the last half century. It has provided the impetus and support of much of what we do in our day-to-day clinical activities and has been translated into the standard of everyday care of our patients. The impact that this has had on our patients' health cannot be underestimated. It is essential that we continue to maintain our research efforts into the future. The underfunding of cardiovascular research at the national level represents a major barrier to the continuation of our success and places future generations at risk of experiencing heart disease.