Q&A: Medical Dean Robert Alpern on decreases in federal research funding

The loss of federal funding for medical research has been making headlines for years and continues to be a subject of debate at medical schools nationwide and in the halls of Congress. In a paper published by Science Translational Medicine on May 27, Yale School of Medicine Dean Dr. Robert J. Alpern joined fellow deans at more than a dozen top medical schools across the country to examine the current state of research funding. YaleNews asked Alpern, who also is the Ensign Professor of Medicine (nephrology) at Yale, about the impact of reduced funding on research, on researchers, and on patient care.

Why did you decide to co-author a paper, with deans at peer institutions (Columbia University, Johns Hopkins, Albert Einstein, and others), about biomedical research funding?

The other deans and I were concerned that there was a misunderstanding among some elements of the scientific community with regard to institutional investment in research. We wanted to make it clear that medical schools invest large amounts of money in biomedical research, even when it is also funded by the National Institutes of Health (NIH).

The paper notes that research funding from institutions such as Yale has grown faster than any other source of support in recent decades, and that such institutions now spend an average of 53 cents of every research dollar. To give perspective, how does that compare to past investment?

It is difficult to provide exact numbers, but about 10 years ago I estimated that Yale was supporting 15 cents for every research dollar.

What about other sources of research support — state funding, philanthropy, tuition, clinical income? What’s the status of these sources, and are they comparable to federal research dollars?

No, the federal government is the largest source of funds. In addition, while the federal government does not cover the full direct and indirect costs of research, other sources provide less, certainly toward the indirect costs, such as administrative costs. Tuition does not support research. Clinical income does not directly support research, but provides unrestricted funds that can be used to support the shortfall in research support. There is concern that these clinical funds may shrink in the future.

You address the issue of faculty salaries and the pressure researchers face to secure funds to cover their own salaries. How has that pressure affected researchers and research at Yale and elsewhere? 

Researchers have always faced the pressure of covering their salaries from grants. However, in the past the best researchers were confident of being able to do so, and if they did not, institutions could assist.  Now, as funding is getting very tight, this is becoming a major issue for researchers, and they are much more concerned. There is also a concern about the ability of institutions such as Yale to fill the gap if it gets too large. I do believe that as an institution, support of our faculty should be one of our highest priorities, but it could limit our investments in other areas of the research enterprise.

What would you say to those who suggest shrinking the size of biomedical research efforts — through greater efficiency, for example?

We are already very efficient. Most of the inefficiencies arise from onerous federal regulations that keep growing every year.

There may be a need to limit or shrink the size of the research enterprise, but that will limit our ability to pursue better approaches to prevent disease and diagnose, treat, and cure our patients.  Biomedical research has never been so well positioned to address healthcare, but to pursue this requires research funding.

What is the “21^st Century Cure Act” being developed by Congress?  What aspects would you support? Not support?

My understanding is that this legislative initiative relates mostly to the Food and Drug Administration (FDA). It also contains language that increases the NIH budget, which would be excellent. While I am always hesitant to support bills that I have not fully read, from what I understand I am in support. We definitely need a more robust and better funded FDA and NIH.

In addition to this collaborative paper, how might YSM continue to advocate for federal support of biomedical research?  

We continue to advocate with the federal government, but probably the most effective advocacy comes through our membership in national organizations that have more influence, such as the Association of American Medical Colleges (AAMC), a non-for-profit association that supports education, research, and patient care at member medical schools and teaching hospitals across the United States and in Canada.