Could Cutting NIH Funding Delay the Next Alzheimer’s Breakthrough?

Article Content

Dr. Jim Brewer, professor and chair of the Department of Neurosciences at UC San Diego School of Medicine and director of the Shiley-Marcos Alzheimer’s Disease Research Center, recently traveled to Washington, D.C., as a guest of Rep. Scott Peters for President Donald Trump’s joint address to Congress on March 4. As the leader of the top National Institutes of Health (NIH)-funded neuroscience department in the country, Brewer met with lawmakers to highlight the devastating impact of proposed funding restrictions—cuts that could threaten life-saving biomedical research and stall progress in the fight against Alzheimer’s and other complex diseases.

The Trump administration’s proposed cap on NIH indirect cost reimbursements would result in an annual loss of more than $150 million at UC San Diego alone. These funds are critical for supporting the infrastructure, technology and specialized resources that drive cutting-edge discoveries.

In this Q&A, Brewer shares insights from his trip to Washington, his message to lawmakers and why sustained investment in research is the foundation for the next life-saving breakthrough:

You were recently invited to Washington, D.C., as Rep. Scott Peters’ guest for the President’s address to Congress. What did it mean to you to have the opportunity to advocate for your research and represent UC San Diego at the federal level?

Overall, it was excellent to be able to have a voice. I think that’s what America is about. It certainly was an honor to be invited by Congressman Peters—who really is an advocate for science—and to learn what drives him. I was heartened by his take on the proposed NIH funding restrictions and by his intelligent and thoughtful approach: If you’re going to do cuts, do it with a scalpel rather than a sledgehammer.

The experience allowed me to connect with representatives from across the country and to share what’s happening from a frontline standpoint—not just the potential impacts of the proposed NIH funding restrictions, but the immediate impacts caused by cancellations or delays of review advisory council meetings and study sections. I think that it raised some awareness among our representatives at a level that they hadn’t previously understood. It seemed that many of them had thought only about the cuts, but the disruption that’s already taking place came as a surprise. There are 14 Alzheimer’s centers across the country that will run out of funding by April 30 due to the delays in council meetings. Many of these centers have excellent to near-perfect scores, yet because the council is not meeting, they are not getting notification that their award is in. If they can’t bridge the funding, they’re going to have to release staff and not be able to continue their work.

Your Alzheimer’s research program is the longest continuously funded project of its kind in the country. What has sustained NIH funding meant for your ability to make breakthroughs?

It’s critical. Continuous funding from NIH has allowed UC San Diego’s Shiley-Marcos Alzheimer’s Disease Research Center, which was established 40 years ago, to be a trusted partner of the community and to build robust connections across San Diego County. We’ve been around long enough that they know who we are, and it has also allowed us to follow participants across this very slowly progressing disease, giving us a viewpoint that’s on the decade level. That’s how this disease needs to be studied: You can’t just get a snapshot or a brief snippet. 

We have had participants who we followed for 30 years who have then donated their brain for continued research at the end of their life—and that’s absolutely one of the most critical resources that you can have in fighting this disease. Our center is sought out across the country and the world for its valuable data that we’ve gathered over the past four decades. These resources are critical, and to throw it all away without much thought would be unfathomable. That is not a cost-saving measure.

You’ve developed neuroimaging techniques to detect Alzheimer’s earlier, which are now being used to monitor the safety of new drugs. Why is early detection so important, and how could funding cuts impact patients’ access to these advancements?

Over the past decade, there’s been a sea change in the field, driven by biomarkers. We finally can look in the living patient and know whether they have the underlying proteins of Alzheimer’s. That changed everything. We found that up to 30% of patients we previously thought had Alzheimer’s disease did not have Alzheimer’s, but a different dementia. When 30% of your patients don’t even have the disease you’re targeting, you can imagine how that slows your ability to develop effective drugs. It’s absolutely critical to have markers that can give you an accurate diagnosis so that you can tailor your trials to those who actually have the illness.

To pull funding at this point would be to absolutely cut the knees out. We have such tremendous momentum in making major impacts on this disease—one that experts say will bankrupt America’s health care system if we don’t address it. If you’re on the cusp of curing or treating an illness with that degree of economic impact, you don’t cut funding to that program.

Alzheimer’s is a disease that touches nearly every family in some way. Given the devastating nature of this disease, how critical is it that we continue to invest in research like yours, and what’s at stake if that funding is cut?

It’s a disease that really takes away your independence, and therefore it not only impacts the patient, but also the supporting family members and caregivers around them. What we do at our center goes beyond the science to stop the illness—we provide support groups for patients and their caregivers, which is not something that’s typically provided in standard care of patients with Alzheimer’s. One caregiver told us, “This support group saved my life.” That is a keystone of the comprehensive care that we’re able to give at UC San Diego and taking that away would be an absolute travesty.

Another mainstay at stake is clinical trials. I think a lot of people see clinical trials as experiments, but in academic health centers, clinical trials have become part of health care itself. They’re often the patient’s last hope. They provide the patient access to the very cutting edge of what is coming down the pike in medicine. Clinical trials also allow us to develop techniques and processes that will make these drugs and other therapeutic approaches safer. Cutting our ability to enroll patients in clinical trials would not only harm this country’s capacity to develop the safest drugs and to stay at the forefront of medical innovation but also would impact current patients and their immediate care. This is a complex ecosystem, and if political leaders don’t understand it, they can do major damage when trying to adjust it.

UC San Diego is at the forefront of biomedical research, driving advancements that impact patients far beyond our region. What makes this research ecosystem so vital to national and global health progress?

Academic medical centers are a wellspring of ideas and talent that drive our economy and our nation’s leadership in health care. Within the San Diego region, there are 400-plus biotech companies that are fueled and propelled by the innovation of not only UC San Diego but the “mesa of scientific prowess”—Sanford Burnham Prebys, Scripps Research and the Salk Institute, to name a few. It’s an environment like no other. It’s no accident that San Diego’s strength in genetics and in the broader neuroscience industry is driven by this unique intellectual environment that’s here, and UC San Diego is the cornerstone of that environment.

What needs to be done to ensure the long-term sustainability of U.S. medical research and maintain our leadership in innovation?

There are burgeoning efforts—and we hope UC San Diego takes a major lead—in increasing transparency of scientific results so that we can regain the trust of the public in the reliability of our results. I think what needs to be done to ensure the long-term sustainability of medical research is to engage the public, spend more time interacting with the public and communicate effectively the importance of what we do so that they don’t lose faith in us.

There have been concerns that cuts to NIH funding will discourage the next generation of scientists from pursuing careers in biomedical research. What could this mean for the future of your field?

It’s disheartening to hear brilliant young scientists say, “Is this a stable career? Do I really want to do it?” And that is terrible. If we want to sustain leadership, we must have a new generation and a pipeline of brilliance that comes to this field. The route to that wellspring of talent is through academic medical centers, and that should be the last place you want to cut. This is like a Jenga tower. You pull out the wrong keystone and everything crumbles.

My fear is that in response to the possibility of these cuts, we might make some rushed decisions with long-lasting detrimental impacts. In the medical field, we are trained in a counterintuitive concept: “In panicked situations—like a code blue—don’t just do something; stand there.” That is, if you come into a crisis, before you implement risky actions and reactions, take some time and effort to assess and  understand the situation, because if you don’t, you have the risk of doing major harm that may be difficult to reverse. The same advice goes to individuals on both sides of this crisis. Be thoughtful about impacts and unintended consequences, because acting in a rash manner could jeopardize the entire ecosystem.