Given the stalemate in decision making on healthcare and research funding in Congress, the recent $400 million surge in funding for Alzheimer’s dementia and related disorders at the National Institutes of Health (NIH) is worth celebrating.
Yet, the devil is in the details.
This new influx of money provides a plot analogy loosely reminiscent of the 1985 movie "Brewster’s Millions." In the film, a wager for $300 million is at stake and to earn that, millions need to be spent in a short time frame.
But the Alzheimer’s funding plot quickly deviates from the movie analogy, as there is no promise of additional funds for next fiscal year — or beyond.
The proposed budget for the next fiscal year suggests a 20 percent cut to NIH funds, with no specific recommendations about Alzheimer’s funding at that point. The NIH is the largest funder of dementia research.
If these cuts become a reality, current and future research projects would take a direct hit and the indirect consequences to patients, families and future researchers may be even larger.
Increasing age is the biggest risk factor for Alzheimer’s. This fact, paired with the aging of the baby boomer population, suggests the number of those with Alzheimer’s is estimated to grow from 5 million to 50 million by the year 2050 unless a treatment to prevent, slow or cure is identified.
One research report estimates that delaying onset of Alzheimer’s for five years would result in a 41 percent lower prevalence and a 40 percent lower cost of Alzheimer’s treatment in 2050.
These short-term boosts in funding to the NIH may appear to be sufficient to make a lasting difference. But it is important to understand the landscape of dementia funding over time and the investment in it relative to other major diseases.
Alzheimer’s is the sixth leading cause of death in the United States. With the exception of the past two years, Alzheimer’s research was funded at embarrassingly low rates relative to other diseases in the top 10 causes of death.
For example, NIH investment in Alzheimer’s research in 2011 was less than $450 million, while investment in cancer, heart disease and HIV/AIDS was 6-12 times more, ranging from $3.1 billion to more than $6 billion.
The consequences of this low investment in dementia research funding resulted in abysmally low funding levels at the National Institute on Aging of the NIH, hovering around 10 percent of all applications receiving funding. Applications are primarily from leading researchers at universities, hospitals and similar organizations, with over 3,000 applications submitted in 2016.
The 2017 Alzheimer’s Association annual Facts and Figures Report provides a sobering public health reality. From 2000-2014 there was a 9 percent decrease in death by prostate cancer, a 14 percent decrease in deaths resulting from heart disease and a 21 percent decrease in death by stroke.
Yet deaths from Alzheimer’s disease increased by 89 percent.
Is there a distinct causation between research efforts and mortality decreases? Some would say yes, as the more funding directed at a specific disease does result in new solutions and treatments, as we have seen in breast cancer and HIV.
With that in mind, it is unfathomable that we do not target more research funding at a problem that is growing because of increased life expectancy and the aging of the baby boomers.
In recent years, NIH’s investment in Alzheimer’s research has taken a promising leap toward respectable funding levels, but sustained investment is required.
A model of patchwork rather than long-term funding is problematic for current and future research projects aimed at improving the lives of those with dementia.
The cycle from submission to funding of a research project at the NIH is approximately one year if the project is lucky enough to receive funding on the first try. The time frame doubles if additional submissions are needed. The research proposed projects can last up to five years.
Simple logic suggests that if fewer projects are funded because of insufficient research funds, there will be fewer opportunities for success in biomedical research.
Low funding rates or the uncertainty of sustained funding threatens delay in the development of treatment options, ultimately hurting patients and families. To be sure, some might argue that the unfunded grants were unfunded for a reason. Certainly, the proposals may have been flawed or underdeveloped.
But counter arguments include the notion that a slim funding line stifles opportunity for innovative projects, new ideas from rising researchers, and that the low funding lines did not result in a prevention or cure.
In a 2016 Harris poll, those surveyed endorsed scientists as the second most prestigious profession at 83 percent, behind doctors at 90 percent, and ahead of firefighters at 80 percent.
While such prestige may initially entice promising young talent to academic biomedical research, they may not stay with this career choice.
Instability in funding is likely to repel rather than attract future talent to Alzheimer’s research. There are now more scientists outside versus inside academia. As a researcher and mentor at a major university, I am concerned about viability for research moving forward.
There is no cure for Alzheimer’s yet and the next steps are critical. Sustained investment in Alzheimer’s research is what we need, with long-term funding goals and plans in place, not a haphazard approach to funding as if all the lives at stake do not matter.
Emily Rogalski is a clinical and translational neuroscientist and associate professor at Northwestern Medicine’s Cognitive Neurology and Alzheimer’s Disease Center.