Deep cuts to the nation’s premiere research agency under President Donald Trump’s proposed budget have left the industry concerned about the impact it will have on precision medicine and major research programs like the Cancer Moonshot initiative.
Released last week, the president's proposed budget calls for a $5.8 billion cut to the National Institutes of Health (NIH) in 2018, representing the largest chunk of the $15 billion reduction to the entire Department of Health and Human Services.
Although it’s unclear exactly how those cuts would directly impact personalized medicine, researchers and precision medicine advocates raised concerns about how deep cuts the NIH would have a broader impact on efforts to advance precision medicine.
“I think [the NIH budget cut] would be cataclysmic, beyond devastating, since it is not only a profound cut, but it is also coming at an especially momentous time of biomedical research,” Eric Topol, M.D., director of the Scripps Translational Science Institute and a professor of genomics at The Scripps Research Institute, wrote in an email to FierceHealthcare.
Edward Abrahams, president of the Personalized Medicine Coalition, added that the 20% reduction to NIH will “undoubtedly” impact major research projects like the Precision Medicine Initiative.
“If you cut holes into the bedrock of biomedical research that supports future innovation in healthcare, everyone is going to suffer, and we’re especially concerned the promise of personalized medicine can and will be undercut,” he told FierceHealthcare.
The American Medical Informatics Association (AMIA) raised similar concerns that the Cancer Moonshot initiative and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative would find it difficult to “deliver on their potential with a 20% cut to NIH.”
“Basic research done at the bench in universities across the country is interconnected to treatments delivered at the bedside,” the organization said in a statement. “So, even targeted cuts at one end of the discovery spectrum will impact the whole.”
Major medical associations weighed in with additional apprehensions. The American Medical Association said in a statement sent to FierceHealthcare that it has “grave concerns” about the NIH cuts. The American Cancer Society Cancer Action Network, was more forceful, indicating the cuts would “set back cancer research two decades.”
Many pointed out the inconsistencies with the president’s budget compared to the 21st Century Cures Act enacted in December, which features more than $1.4 billion in funding for the Precision Medicine Initiative over the next 10 years, including $1 billion in FY 2018. The law also directs nearly $4.8 billion to the Cancer Moonshot and NIH Innovation Projects, including $496 million in FY 2018.
Abrahams said both of these initiatives are the “tip of the spear” for personalized medicine and enjoyed bipartisan support during the creation of the 21st Century Cures Act. For that reason, he doesn’t believe the president’s cuts to NIH have any chance of passing the House or Senate. Perhaps more concerning, however, the budget may indicate the president doesn't have a firm grasp on the potential impact of precision health.
“If Trump understood what personalized or precision medicine was all about, he would be reluctant to move so forcefully against it, since it addresses so many of the things he cares about—mainly, how you persevere innovation and reduce overall systemic costs,” he said.
During a press briefing on Friday, White house budget director Mick Mulvaney justified the cuts to NIH, saying there has been “mission creep” within the agency. White House Press Secretary Sean Spicer added that there should be a review of all agencies to see if they are achieving their mission, but offered a confusing justification for the NIH cuts.
“There’s this assumption in Washington … that if you get less money, it’s a cut,” he said.
The Office of Management and Budget did not return requests from FierceHealthcare to clarify whether NIH cuts would impact funding for the Precision Medicine Initiative or the Cancer Moonshot.
Health IT implications in AHRQ consolidation
Precision medicine isn’t the only target. Trump’s budget calls for “consolidations and structural changes across NIH organizations and activities,” including the Agency for Healthcare Research and Quality (AHRQ), which plays a critical role in funding research devoted to health IT.
In the past, AHRQ has funded research tied to e-prescribing, evaluating meaningful use requirements and clinical decision support. In fiscal year 2016, AHRQ spent more than $21 million on health IT research. The year before, the agency spent more than $28 million.
HIMSS was particularly disappointed to see the cuts to AHRQ.
“Through our participation in the Friends of AHRQ, we will continue to make our case to Congress and now to the White House that the agency plays a unique and critical role in the health services research space,” the organization said in a statement sent to FierceHealthcare. “AHRQ-funded health IT research and tools are and will continue to be important drivers for optimizing IT to improve the quality, safety and efficiency of care delivered to patients and reduce costs in our healthcare system.”