With just hours left before President Bush lifts the veil from his 2004 budget request, the National Institutes of Health is bracing for a serious case of whiplash.
That's what it's going to feel like, experts said, as the nation's largest funder of biomedical research ends its five-year run of 14 percent to 15 percent annual funding growth and hits the wall of a 2 percent increase, which sources inside and outside the government say Bush has settled upon.
The ripples from that impact will affect tens of thousands of scientists who depend on NIH grants, analysts said, and over time could make a difference to millions of Americans who are counting on the NIH to deliver new treatments for the bedside.
Administration officials say the cutback in growth is less severe than it appears once unique expenses for bioterrorism in 2003 are accounted for. But by other measures, the expansion of the NIH's mission to include bioterrorism has exacerbated the funding crunch, forcing advocates for research on everyday diseases to scramble for support. Under Bush's plan to fund the NIH at $27.9 billion, for example, the number of nonbioterrorism research grants awarded by the NIH next year will drop. Such a decline has happened only once since 1989.
"It will be shocking," said Donald C. Poppke, the NIH's acting associate director for budget. "The response will be fairly negative."
With looming federal deficits and the prospect of an expensive war in Iraq, nearly every federal enterprise is under pressure to trim its budget. But few agencies stand to lose as much momentum as the Bethesda-based NIH, which is just now closing the books on a historic five-year funding sprint that had aimed to double its budget by this year from $13.6 billion in 1998. That remarkable push, accomplished through a bipartisan effort, attests to the NIH's popularity on Capitol Hill and to the political muscle of advocacy groups seeking funding to battle dozens of diseases.
Now it appears the agency is poised for a triple hit: The still unsettled 2003 budget is expected to fall about $1 billion short of the president's promise to complete that five-year doubling. The newly proposed 2 percent increase for 2004 would cut by three-quarters the steady 7.5 percent to 8 percent growth rate the agency had enjoyed before the five-year effort. And the 4 percent annual "cost-of-doing-research" increases already promised for ongoing grants are to be scaled back to 1 percent per year.
Taken together, the numbers have many NIH-watchers wondering whether the nation's primary biomedical research engine will stall as it tries to keep its beefed-up research pipelines flowing.
The cost of doing research grows faster than conventional inflation, which means the 2 percent increase is unlikely to result in even a steady budget, experts said. That means the NIH may be hard-pressed to maintain the funding of existing grants, which typically run for four years each, and would have to cut back sharply on its support for new and innovative proposals.
Just which lines of research will be hardest hit won't be known until the NIH goes through its grant-making cycle, but it would take just a few years of flat budgets or small increases, experts noted, to lose completely the fiscal boost that the five-year doubling has accomplished.
"Two or three years of 2 or 3 percent increases, and you've pretty much lost what you've gained," said Dave Moore, associate vice president at the Association of American Medical Colleges. "And you've certainly lost the morale of investigators who can't help but be demoralized by trying to compete for funding under those circumstances."
That threat has inspired some on Capitol Hill to call for granting the agency a budget growth of at least 8.5 percent annually over the next three years, which would result in a tripling of the NIH budget between 1999 and 2008.
The NIH is by far the largest federal grant-giving agency for the biomedical sciences. Its 27 institutes and centers support 50,000 primary investigators and countless other laboratory workers at more than 2,000 institutions. The Bethesda campus itself is home to dozens of major research labs; to the National Library of Medicine, which operates the world's largest online database of scientific journals; and to a bustling clinical research center that admits 7,000 patients a year and coordinates outpatient studies involving another 72,000 participants.
Congress has often voted for more funding for the NIH than the president requests. This year, however, the pressure to hold spending growth nearly flat is greater than ever.
Administration officials have done their best to put a positive light on the proposed 2 percent increase. They note that if $1.4 billion in unique bioterrorism-related expenditures in 2003 are not counted -- including the one-time funding of new biodefense research buildings and a $250 million purchase of anthrax vaccine -- then the 2004 budget request would represent a 7.4 percent increase over the 2003 budget, assuming Congress settles on about $27 billion for 2003.
In a less extreme but still generous analysis, administration officials have calculated that the 2 percent increase for 2004 embraces a 4.3 percent increase in nonbioterrorism research dollars. That's a far cry from previous increases, but not bad under the current economic circumstances, said the NIH's Poppke.
"We all knew at the time that the five-year doubling was historic and it would end at five years," Poppke said. "And there will be lots of spin-offs" for medicine, he said, from the new spending on bioterrorism.
But others dismissed those calculations as "spin." For example, some noted, although the bioterrorism building and infrastructure costs for 2003 are high, the need for new construction is ongoing.
"We've doubled the size of the enterprise, but we have a lot of people working in buildings that are 30 or 40 years old," said Patrick White of the Federation of American Societies for Experimental Biology (FASEB), which is recommending a 10 percent increase in NIH funding for 2004. "We can't just stop paying attention to infrastructure."
Although the dollar amount of nonbioterrorism research would increase marginally under the president's proposal, the number of nonbioterrorism grants in 2004 would decline to 9,487, down from 9,724 this year. By contrast, the number of bioterrorism-related grants is set to nearly double to 661, from this year's 338.
Daniel E. Smith, national vice president for government relations at the American Cancer Society, said it would be a mistake to trim growth at a time when advances in molecular biology are finally offering cancer patients higher survival rates and a better quality of life.
"We see the money that's gone into NIH as a little like Miracle-Gro for cancer research, and if you don't finish the doubling, you'll stunt the growth of the research," Smith said. With cancer costing the nation more than $60 billion in medical expenses and more than $171 billion in related costs, the cancer institute's roughly $4.5 billion budget is a bargain, Smith said.
Sens. Arlen Specter (R-Pa.) and Tom Harkin (D-Iowa) recently introduced a resolution to triple the NIH budget during the decade ending in 2008. Now, with the ink on the president's budget barely dry, advocates for research are preparing for battle.
"We're very grateful to the administration and the American people for their investment in NIH and biomedical research, but this is not the time to be penurious or restrictive," said FASEB President Steven L. Teitelbaum "This is not a subsidy, but an investment. We hope we can convince the administration and Congress that this is the wisest investment they can make."