An Open Letter to Congress

by Guy McKhann, M.D.

April 4, 2017

This is a column from Dana's print publication, Brain in the News.

Recently, President Trump presented his first budget proposal: substantial cuts in health-related programs, including an 18.2 percent cut (equaling about $5.8 billion) to the National Institutes of Health (NIH). The president’s proposal is a guideline that Congress responds to as they develop the actual funding bills.

The average age of members of Congress is around 57 in the House and 63 in the Senate. Our representatives are approaching the ages when neurodegenerative diseases appear. As a person approaches 80, there is at least a 20 percent chance of developing a dementing illness, particularly Alzheimer’s disease. At 85, the chances approach 40 percent. If we do not come up with methods of either slowing the progression of the disease or returning a person toward more normal cognitive function, this one disease group could break any health plan that can be devised. Further, dementing illnesses are a tremendous financial drain on our society. There are costs involved in patient care, and loss of productivity and increased suffering of caregivers. In 2016, that cost was $261 billion, an amount that will grow as the entire population continues to age.

Advances in medical research are a slow process, dependent on not only established senior investigators but also a continuing influx of bright young people, with new ideas and new approaches. Attracting young talent is a continuing struggle, since they have many other more certain, career pathways. If we all but eliminate support for those just starting out, we stand to lose many of these potential scientists.

We have made substantial progress in understanding these diseases. For example, we now know that Alzheimer’s disease starts years before it becomes a clinical entity. Further we have biomarkers, changes on brain imaging or in cerebrospinal fluid, that make it possible to determine who is at risk for the disease, and to predict when the disease will materialize. What we don’t have are the medications or procedures to utilize this newfound knowledge to alter the course of the disease. I am quite optimistic that, with the help of the many bright people in industry, academia, and the government, we will find solutions to previously insolvable problems. In other circumstances, if you do a job well, you are often given a bonus or raise. Here, researchers are being given a disincentive—an 18.2 percent cut in funding.

This column could have been written from any number of health perspectives: cancer, heart disease, mental illness—you name it. In each case, as Congress contemplates cost savings, the message would be the same. Too many problems remain to be solved.