Despite some good aspects, President Trump's proposed 2018 budget includes cuts in biomedical programs that would cripple life science research and industry, experts say.
"It's a horrendous proposal," said Dr. Eric Topol, a cardiologist-geneticist with Scripps Health in San Diego. "Every way you look at it, it spells trouble."
The proposed cuts also would come at a time when biomedical research has become extraordinarily productive in finding new treatments and insights into human health, Topol said.
The National Institutes of Health is the nation's largest funder of biomedical research. Under Trump's proposal, its budget would fall 22% to $26.9 billion. Nearly all of its component institutes would get a drop in funding.
The National Cancer Institute would get $4.47 billion, a loss of about $1 billion.
The National Institute of Allergy and Infectious Diseases would get $3.78 billion, a loss of $838 million.
The National Institute on Aging would get $1.3 billion, a loss of $294 million.
The budget does contain some new spending, including $207 million for the Department of Health and Human Services to respond in case of an influenza pandemic, an increase of $135 million.
The California Life Sciences Assn., a biomedical trade group, is "deeply concerned with the administration's requests related to public health and research priorities," the group's president and chief executive, Sara Radcliffe, said in a statement.
Radcliffe did praise the administration's proposed repeal of the Independent Payment Advisory Board. She said the board — which was established with the Affordable Care Act and which the Obama administration pitched as a way to help Medicare provide better care at lower costs — "could harm biomedical innovation by reducing incentives for investment in new research and product development."
Joe Panetta, president and CEO of Biocom, the life science trade group for California, said the Trump budget's combination of cuts to the NIH, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the National Science Foundation would be "devastating."
Not only would research be hurt, he said, but cutting CDC and FDA budgets would also reduce their ability to monitor and treat diseases.
The cuts would hurt the large biomedical economy across California, Panetta said. NIH grants pour hundreds of millions into research institutes in Southern California. Other programs, such as Small Business Innovation Research grants, help companies advance technologies so they can be commercialized.
Topol said the methods used to effect the budget savings would also disrupt research. High on his list of disrupters is a proposed cap on grants that cover indirect costs of research — costs such as space and utilities.
Indirect costs are currently calculated on a percentage determined for each institution, based on audited data, Topol said. Rates often range from 40% to 50%, and in some cases all the way up to 100%, Topol said.
"To suddenly make that 10% would basically cripple all biomedical research," Topol said.
The NIH has recently advanced a good proposal to fund more young researchers by giving them priority, he said. But the budget reductions would have the opposite effect, discouraging young researchers who are trying to get their feet on the ground.
Panetta said a proposal to fund the FDA by charging about $670 million in user fees to biomedical companies for reviewing their products could make the agency too dependent on the biomedical industry.
These user fees — introduced in the early 1990s — are a good idea, Panetta said, but the proposed increase takes that concept too far.
"The industry's already paying 80% of the budget in user fees," Panetta said. He said he thinks the industry can afford the increase, "but that's not the issue…. How much of the FDA do you want to be funded by the industry?"
The national Biotechnology Innovation Organization expressed a mixture of praise and concern about Trump's proposed budget.
"We are encouraged by the proposals to clarify the treatment of value-based purchasing arrangements and to promote enhanced sharing of scientifically sound information between manufacturers and payers," the group's president and CEO, Jim Greenwood, said in a statement.
Like Radcliffe, Greenwood praised the proposed elimination of the Independent Payment Advisory Board.
"However, we have concerns about the proposed re-opening of technical FDA user fee negotiations as well as some of the proposed funding levels for key scientific and public health preparedness programs," Greenwood said. "We look forward to working with members of Congress on both sides of the aisle, as well as the administration, to ensure that these critical programs supporting public health and basic biomedical and biobased technologies research receive adequate funding."