Sequestration and the Unintended Politics of Cancer Research

“We cannot step aside and say that we have achieved our goal by inventing a new drug or a new way by which to treat presently incurable diseases, a new way to help those who suffer from malnutrition, or the creation of ideal balanced diets on a worldwide scale. We cannot rest till the way has been found, with our help, to bring our finest achievement to everyone.”                                            

                                                                                               —  George W. Merck

INTRODUCTION:

We are all too familiar with the logjam in Washington and the lack of bipartisanship, let alone civility.  It is not a pretty sight.   One of the major issues over the last several years has been cutting the “deficit,” and, in particular, the question of how to accomplish any such cuts. The options frequently discussed are cuts to what are commonly referred to as “entitlements,” raising taxes on the wealthy, or some combination of the two.

As a result of this debate, we have become familiar with a big word with bigger consequences – Sequestration.  The concept of sequestration was put into effect as part of the Budget Control Act of 2011.   Sequestration is based on what one would think is logical – set up mandatory future budget cuts that are so unappealing to everyone that Congress has the incentive to address the issue by coming up with an agreed upon plan to trim the federal budget – in a thoughtful and prudent way.  If Congress could not come up with such a plan by March 1, 2013 (originally, January 1, 2013), sequestration would go into effect.

We expected too much of Congress.  March 1 has come and gone.  Congress could not agree upon a plan.  Sequestration is here.  Although Congress can still intervene, cuts are now a reality.  They are being felt.  They are harmful and speak volumes about the priorities of this country.

We know that one effect of sequestration was to cause an increase in flight delays due to mandated FAA budget cuts.  We also know that such delays were not palatable to Congress.  In fact, as CNBC has explained, Congress recently passed a bill ordering the FAA to use general airport improvement funds to pay the salaries of air traffic controllers, thus putting an end to furloughs of air traffic controllers that had delayed thousands of flights across the country.  Those now-fixed delays, of course, made it more difficult for members in Congress to travel.

CUTS TO CANCER RESEARCH:

We also know – or should know – that another effect of sequestration is to cut funding for cancer research.  The Cancer Letter, a weekly newsletter discussing cancer research and funding, states that the National Cancer Institute will face a budget cut of $219 million for the remainder of this fiscal year.  NCI Director Harold Varmus has stated that for NCI to maintain the level of grant awards and renewals that it has in the past several years, it will need to make “significant” cuts in other NCI programs, including cancer research contracts and non-competitive grant renewals.  (The Cancer Letter.)     Yet, as Mr. Varmas also has said, because money already has been committed to ongoing studies that last several years, the cuts to grants for new research could be as much as 40%,   (City of Hope Blog.)

Sequestration thus likely will jeopardize laboratory research.  As the President of the highly respected Dana-Farber Cancer Institute, an NCI Comprehensive Cancer Center, has stated in a blog, with prospects for grants increasingly uncertain, “some scientists may struggle to keep their laboratories running.”   He adds that creative research projects, which he calls “out-of-the-box” research, will lose funding so that basic research can be continued.  (Also, as discussed below, there is a legitimate fear that we will lose a generation of cancer researchers.)

The same fate may await clinical trials.  As CNBC reports, “the sequester will mean fewer clinical trials for promising therapies, and some patients ultimately will be turned away from these trials.”   To try to avoid cuts to clinical trials, cancer centers are instead cutting other research (the sort of laboratory research discussed above), including research that could lead to new discoveries.  The Huffington Post has reported that sequestration has jeopardized the ability of many cancer patients to continue to participate in clinical trials – causing them to have to travel thousands of miles to continue to participate in a trial.  As one doctor explained in the Huffington Post article:  “These are cancer patients. It is not like they have a case of the flu or the sniffles or something. If they are on a clinical trial they are on the end of their rope. They don’t have energy or resources. This is it for them. To put that burden on them is really absurd.”

Sadly, sequestration already has caused some cancer patients to be deprived of chemotherapy.  As was recently reported in the Washington Post,  “[c]ancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.”  As the article in the Washington Post explained, “[0]ncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive  chemotherapy drugs while staying afloat financially.  Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.”

THINKING IT THROUGH:

What does this mean?  Absent Congressional action, sequestration portends potential disaster for cancer research.  It jeopardizes current and future research, particularly the innovative research that falls outside the typical research tunnel.  The effects may be long-lasting.  Not only will it be impossible to make up for delayed or lost research for current cancer patients or those soon to be diagnosed with the disease, it may mean, as the President of Dana-Farber says, the loss of “a generation of young scientists.”  As the Deputy-Director of research at City of Hope, another NCI Comprehensive Cancer Center, explains, “[t]hat sounds dramatic, but it’s true.  Some brilliant young scientists will just say there are easier ways to make a living than cancer research.”

Why is this happening?   The simple answer is the concern many have about the deficit and its effect on the economic potential of the US.  The emerging issue is whether a reduction of funds allocated for cancer research is the right path for any civilized country to follow, especially one where the wealth of so many is such that raising taxes is or should not be out of the question.  Cuts to cancer or other biomedical research (or any social or other program – many of which are valuable and of great assistance to this socially advanced country) reflect the priorities that Congress sets for this country.

What can be done?  The cuts to cancer research (and, for many, the increased difficulties of obtaining treatment) demand a public outcry and contact with one’s respective legislators.   Even more importantly, they also call out for us to evaluate our own priorities and our philanthropy.  Do we want to sit idly by or do we want to donate to cancer research – and/or other valuable biomedical research or other highly regarded and worthwhile programs – that will improve the status of those around us, whether or not we will directly benefit from the programs?   Where do you stand?

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