Post by Former NIMH Director Thomas Insel: Investing Wisely in Public Health
The biomedical philanthropist Mary Lasker once famously quipped, “If you think research is expensive, try disease.” This comment is even more relevant today, especially in thinking about the high costs of mental disorders.
Of course, this is a time of reduced funding across the federal government as Congress looks to rein in government spending. Members of both parties have stressed the need to reduce the deficit and cut spending. But this is why we must reframe the issue: is research an expense or an investment? The data argue for research as an investment — not a subsidy, entitlement, or conventional government cost.
Consider that NIH funding is an economic engine, creating $68 billion in new economic activity and nearly 500,000 jobs across 50 states in 2010. Recognizing the benefits of such an engine, other countries have begun making large new commitments to biomedical research. The Beijing Genome Institute has just purchased 128 of the new Illumina genomic sequencers, giving China a global edge for commercial sequencing. The Chinese government seems to have no doubt that the economic benefits of research accrue to those making the largest and smartest investments.
One such investment closer to home, The American Recovery and Reinvestment Act (ARRA), can now be viewed as an experiment in investing new research dollars. As part of ARRA, NIMH received $374 million for a two-year investment in 2009. Some of those funds supplemented grants that had been cut back in the preceding years. Some expanded the pool of grants with short-term awards. Some was used to boost the Institute’s autism portfolio.
But the biggest portion went into four signature projects aimed at changing our science. Two years later we can see the return on this investment in a series of new, transformative resources. The Recovery After an Initial Schizophrenia Episode (RAISE) Project, now in 35 sites, is optimizing the various approaches to early intervention following a first episode of psychosis. RAISE has the twin goals of improving clinical outcomes for patients and informing payors of what they could and should cover to avoid long-term disability.
The Army STARRS project has enrolled over 10,000 soldiers in the largest study ever undertaken to understand risk and resilience in the military. At a time when suicides outnumber combat deaths, this project has emerged as a national priority.
A third project, the Developmental Neurogenomics study, is following cognition and brain development in 10,000 children to yield the trajectory and range of normal neurocognitive development.
Finally, the first human brain atlas showing the development of gene expression will be fundamental for the study of mental disorders, most of which are now viewed as neurodevelopmental. This one time investment gives scientists a reference for genomic discoveries. It not only accelerates the pace of discovery, it avoids the need for each group to map their gene of interest, at great expense.
Each of these projects was an investment. And each is paying off scientifically in the short-term but changing research or policy in the longer-term with huge potential economic savings. Mary Lasker was right — research is expensive, but research is our best investment to reduce the much greater cost of disease.