Mexico, module 2, and the subversion of science

Last week I guzzled tequila on a Mexican beach; today I sip coffee in the Neil John MacLean Health Sciences library. My peers and I recently finished “Module 1” of medical school — we’ve now covered all the normal anatomy and physiology of the human body — and spring break came as our reward. For myself and forty classmates, the break provided a prime circumstance for a trip to Mexico. For eight glorious days we lived amongst palm trees, went on adventures both in and out of the resort, and most importantly had a chance to enjoy each others’ company in a non-academic setting. We returned late Sunday night to begin Module 2, the module of disease, early Monday morning.

Just before leaving to Mexico, I glanced at a piece in The Atlantic titled Scientists Brace for a Lost Generation in American Research. Here I learned of President Trump’s plan to cut the budget of the National Institutes of Health (NIH) by one-fifth, a decrease of $5.8 billion. I quickly knew I had something to say about this, but I put my thoughts on hold and went to Mexico. Upon returning to Canada I read a bit further and found it’s actually worse than I initially read: in addition to the $5.8 billion cut scheduled for 2018, Trump also plans to reduce the budget by $1.2 billion between now and then. Since Trump’s inauguration in November there’s hardly been a basis for optimism regarding funding allocation to science, but one might have thought the NIH would be dealt a better hand. Cuts to the Environmental Protection Agency (EPA) are unsurprising, but in fact EPA is losing only $2.6 billion whereas the NIH is losing $7 billion (although proportionally EPA is losing one-third of their budget). Of all the reductions to science funding the Trump administration is seeking, the cuts to the NIH are to me the most depressing.

The NIH is the largest biomedical research agency in the world. It currently operates under the directorship of Dr. Francis Collins, the physician-scientist who brought the Human Genome Project to completion ahead of time and under budget. The great majority of the NIH’s budget (over 80%) is used to create approximately 50,000 competitive grants, which are disseminated across more than 300,000 researchers at more than 2,500 universities, medical schools, and other research institutions. Another 10% of the budget supports projects conducted by the 6,000 scientists in NIH’s own laboratories. In total, the NIH invests upwards of $32 billion dollars each year into life-enhancing and even life-saving biomedical research. This makes it the largest funder of health research in the world.

Scientists don’t ask for much. As the Atlantic piece notes, the work of a scientist is arduous and often unglamorous. (My own experience in a research lab testifies to confirm this.) Advancements and discoveries come at the cost of several lifetimes of work. A research scientist undergoes a decade (sometimes closer to two) of gruelling training to prepare them for a career of investigation and experimentation. Their life’s work is to discover new knowledge that will reduce human suffering brought on by disease. To this end they sacrifice their time, their energies, and their passions. They undertake all this willingly, at the prospect (if not the certainty) of making very little money. All they require is sufficient funding to afford the technology required to test their hypotheses. This technology is almost invariably expensive. Much of health research takes place on the molecular level, for this is the scale at which our biology plays out in its pure, irreducible form. To journey down to this level to test a hypothesis is to become a participant in a strange and mysterious world, a world to which our only access comes in the form of cutting-edge technology. Affording this technology is where the NIH and other similar bodies become involved.

Over the last century or so, life expectancy in the US has increased by thirty years. A lot of this is to do with better healthcare, which comes about only by more health research. Much of health research relates to ameliorating the betrayals transgressed against us by our own bodies. These betrayals are mostly on the molecular level. Cancer is, in a basic sense, the result of betrayal by the cell cycle, such that it ceases to regulate the division of a certain population of cells in the body, allowing them to proliferate unbounded by normal biologic constraints. Multiple sclerosis is a betrayal by the immune system, such that it sends a population of T-lymphocytes to demolish the myelin sheaths that your brain and spinal cord require for proper function. Myocardial infarctions (heart attacks) and strokes are a betrayal of the blood-clotting system such that a clot ends up somewhere it shouldn’t and cuts off the blood supply to an organ, causing tissue death. These betrayals are the direct result of natural shortcomings of our body, part of our innate biology. Overcoming these shortcomings is tantamount in a very real sense to thwarting nature, and Mother Nature does not thwart easily or cheaply. Again, here arises the need for the NIH.

As if the betrayals by own our bodies weren’t enough, we also have a hostile external world to contend with. The first course of Module 2, the course to welcome my classmates and I back from break, is a two-week introduction to Infectious Disease. I find this a neat subject — there’s something sexy to me in the concept of the battle, the notion of waging war against tiny microscopic enemies endowed with powerful weapons. For millions of years these weapons gave the microorganisms dominion over us — it’s only in the last couple hundred years that we’ve roused our ingenuity to devise new technologies enabling us to stand up for ourselves. How many of these technologies exist in part thanks to funding from the NIH? I’m not sure. But once again, standing up to microorganisms is tantamount to standing up to Mother Nature, and Mother Nature does not back down without a fight. A reduction in science funding depletes our war chest and leaves us vulnerable to the natural order of things, which, if you consider the life expectancy of Homo sapiens in the pre-scientific era, is far removed from a circumstance of human flourishing. The smallpox virus killed over 300 million people in the 1900s alone before it was eradicated. That’s one person killed every hour for approximately the next 35 thousand years. It’s worth mentioning death by smallpox involves a great deal of agony. The smallpox-free world we currently enjoy is a world provided to us by health science research. In fact, the NIH helped fund the eradication.

Joy Hirsch, a professor of psychiatry and neurobiology at the Yale School of Medicine, was quoted in the Atlantic piece as saying “It takes only one savage blow to halt our dreams of curing diseases such as cancer, dementia, heart failure, developmental disorders, blindness, deafness, addictions—this list goes on and on.” A reduction of $7 billion to the NIH budget may be just such a blow. It’s not uncommon to see science take blows from one societal faction or another; the intelligent design movement, the anti-vaccination movement, the flat-earth movement, and others have all sought to subvert science in their own way, and have all enjoyed some amount of success. But if humans are to continue to progress and flourish, it’s imperative that science be allowed to progress and flourish. Our continued success as a species depends on science, and science as an enterprise is in the safekeeping of society.

Responding to the NIH funding crisis, Kelly Cosgrove, another professor at Yale, remarked “We will miss important discoveries since most breakthroughs are based on years and decades of baby steps. The hare will win, the tortoise will lose, and America will not be scientifically great.” If the subversion of science continues, I fear it will be even worse than Dr. Cosgrove indicates. How big an impact will a loss of $7 billion have? I’m not sure. Trump’s plan will have to pass through Congress before it becomes a reality, so who knows the magnitude of loss we’ll actually see. Nevermind where this money is going (it’s going towards defence, mostly to fund construction of the wall, but that’s not the point). Even if we consider no other aspect of health science research than its utility, this alone seems to me enough to support and defend it. What advancements do we deprive our future selves and our children of by taking money away from the NIH? In practice we’d never know, but as a thought experiment it’s depressing. Let us do what we can to ensure this thought experiment does not become reality.