The orange elephant in the room: impact on NIH funding?

[Cheesus]

Does anyone with a decent knowledge of US politics care to take a stab at how the Republican victories will impact NIH spending?

My basic knowledge tells me that Republicans are keen on significant decreases in public spending, and in times of austerity medical research funding suffers. Can anyone flesh that out with historical precedent or policy commitments if that might be the case? What are the dispositions of Ryan, Priebus, Giuliani, Gingrich, Trump et al to government-financed medical research?

The question might be too specific for these nascent days...

EDIT: Looking at Trump's victory speech he appears to be talking about a New Deal-style infrastructure project. if someone could let him know that the health of his citizens are part of the infrastructure of the country, that would be great.

 

[Skippa]

It's really rather interesting, because Trump is supposed to be the anti-establishment choice, and the establishment is the problem pwc face... (especially so in the UK)...

So yeah to echo... what does this mean going forward?

 

[Crux]

I dread this will be a complete reversal of everything achieved these past 8 years.



Health care and research will certainly be severed.

 

[Thinktank]

Please don't make this a Trump vs Clinton topic.

 

[Crux]

Please don't make this a Trump vs Clinton topic.

This is so much more than that.

 

[Cheesus]

It's really rather interesting, because Trump is supposed to be the anti-establishment choice, and the establishment is the problem pwc face... (especially so in the UK)...

I fear there is more than one way to undermine the establishment, and supporting the underdog with a chronically maligned health condition may not be the form of anti-establishment action the Trump presidency takes.

I believe the uncertainty we face is to the entirety of NIH funding. If that survives then I am optimistic that ME will continue its apparent upwards trajectory into mainstream research. Having said that, his attitude towards disabled people during the election was extremely offensive. I am finding it difficult to predict how this might unfold.

Health care and research will certainly be severed.

I don't think it is as clear cut as that. We can't debate his other policies here because that would be against forum rules, but there is no clear ideology emerging from his rhetoric to date. It strikes me that the health policy will probably flow from whoever he appoints in his cabinet rather than the man himself.

 

[alex3619]

The only thing I have read about government policy is a 1% decline in spending per year, but not including health or retirement. So does research in ME count as health, or is research considered a separate issue?

 

[lauluce]

I'll borrow your signature, it's great! by the way, who can say what will happen to medical research? who knows, maybe he has a friend or two, or some shares in medical research companies and decides to divert funds to those areas

 

[anciendaze]

Anyone depending on the NIH to solve our problems has failed to learn from experience since the mid 1980s. Anyone thinking politics will solve public medical problems in any straightforward, rational way doesn't understand bureaucracies. We need to make it overwhelmingly clear that the costs of failing to deal with the underlying pathology will greatly exceed the cost of successful treatment.

We also need to make it clear current diagnostic categories are seriously defective. Think about the number of contradictory diagnoses some of us have had. Finer discrimination between artificial categories can lead to "diagnostic fragmentation" which leaves many patients isolated in politically powerless groups with "rare diseases". My perception of rare diseases has changed dramatically over the last 20 years. I'm beginning to think people without some such anomaly are rare.

Yet another aspect is the extent to which people with serious, life-threatening illness can bounce around a medical system without doing anything except running up costs and wasting time while pathology slowly progresses. In a case like Justin30, this can end tragically. His case was far from unique. We need to ask how many such excess deaths of young people are considered acceptable.

We also need to ask how it is that medical doctors can be so thoroughly in the dark about a wide range of medical conditions falling just short of acute. There seems to be little way to tell how well a patient's metabolism, endocrine or immune system is functioning, unless these are broken in specific ways, let alone what is going on in their nervous system. These are the most fundamental questions in medicine, aside from the one of who pays the bills.

From the email that has reached me, I have the impression that a lot of Trump supporters are elderly. (Perhaps I am mistaken.) Our problems are very similar to a list of problems associated with aging, and dissatisfaction with current medicine is widespread among the elderly.

Slow declines of energy, immune competence, endocrine and neurological function are typical of the problems of aging, which affect everyone, yet research lags. The existence of cohorts of young people with rapid onset of similar problems ought to be seen as an opportunity for research applicable to everyone. All people want healthcare which extends useful life, and most have strong negative reactions to the idea of being kept alive on a machine like a ventilator, which is the kind of life extension current medical practice offers.

Many of us have orthostatic intolerance, which is poorly understood by most medical professionals, but we are not alone. This is a serious problem for quite a few elderly people, and results in syncope or falls, and trips to emergency departments. (This may be the point at which a patient is judged incapable of coping at home, and sent to long-term care, which is a huge expense.) Syncope is involved in 30% of ER visits, and this is not cheap. (Years ago I was lucky to get out with a cost of only $3,000. This would be considered a bargain today.) I know of one case in which the patient made 3 trips through the system in a week. This is one way in which medical costs rise dramatically near the end of life. Much of this provides no benefit to patients.

Unless we get better at early detection and prevention of conditions that become life-threatening or disabling the number of those needing long-term assistance from government will keep rising until it breaks whatever financial plans have been made. Medical costs have already defeated most private individuals. The world has already seen far too many political systems in which an elite gets all the benefits, while everyone else with problems suffers and dies early.

No populist political movement can be based on that formula for long. The current gap between the health insurance of U.S. elected officials and that of their constituents is enormous. The complexity of navigating the system set up for political outsiders is formidable. If this current election was more than a change from one elite to another this needs to change. At present those making decisions about public health have little "skin in the game", except for paychecks, which seldom depend on results of medical treatments.

 

[Esther12]

From 'What does Donald Trump’s win mean for science and medicine?' [Answer: no-one knows, but they feel they should be writing about it]

1. What’s he going to do with the NIH?
The National Institutes of Health is still recovering from the deep cuts of sequestration in 2013, and China, paper tiger of many Trump talking points, isslated to outpace the USin science and technology R&D spending this decade, according to the Organization for Economic Cooperation and Development.

And yet Trump has said little of consequence about the issue.He told Scientific Americanthat while “there are increasing demands to curtail spending and to balance the federal budget, we must make the commitment to invest in science, engineering, healthcare and other areas that will make the lives of Americans better, safer and more prosperous.” How he would strike that balance remains a mystery.

At the same time, Trump has been close to former House Speaker Newt Gingrich, who last year called on Congress todouble the NIH’s budget. So there’s that.

But the next president apparently takes a dim view of the NIH as a whole. Last year, when conservative talk radio host Michael Savage offered to take over the roughly $32 billion operation, Trump deemed it a “great” idea that would bring “common sense” to the institution. “Because I hear so much about the NIH,” he said, “and it’s terrible.”

https://www.statnews.com/2016/11/09/donald-trump-win-science-medicine/

 

[*GG*]

I dread this will be a complete reversal of everything achieved these past 8 years.

Health care and research will certainly be severed.

I doubt much will change, and things might possible get better for funding. I am in NH, somewhat politically active. If I had a good synopsis of info to get to him, it could probably happen somewhere down the road!

GG

 

[Woolie]

There's a lot of focus on Trump himself. But I don't fully understand exactly how much power the president as an individual actually has in the US. Stories we hear outside of the US about Obama's presidency would seem to suggest not much?

Its unclear to me who's actually going to be doing the governing in this new regime, who exactly would make decisions of the kind that would impact on MECFS.

Can anyone explain?

 

[mfairma]

I think a lot will depend on how willing and able Trump is to be moderated by people who have experience in relevant areas. One article I read suggested that he is close with Gingrich, who recently advocated doubling NIH budget to mitigate the effect of growing health care costs on public expenditures.

@Woolie, Congress passes bills and the president can either sign those bills into law or veto them. Congress can then override the president's veto, but they need a larger percentage of votes to do so. The president can issue executive orders as well, which are in effect law, but is limited in ability to do so. So, the president doesn't necessarily have huge power in that regard, because Congress can act as a restraint, though the fact that Republicans control both houses of Congress mean that Trump will face less restraint than most presidents, who often don't have both houses controlled by their party to support their objectives. Obama did, I believe, during his first term and Bush did for a period, if I remember correctly. Aside from fears on that regard, people also worry about who he will appoint to the Supreme Court, which has one vacancy now and may have a couple more in the coming years, and who he will appoint to head the various agencies.

Someone chime in if anything I've said is incorrect -- at least about the stuff that's not opinion based

 

[Sushi]

Note Phoenix Rising's rule:

No politics (unless related to ME/CFS), no religion.

Views on religion and politics are personal and important to each of us. This forum is not the place to discuss general politics or religious beliefs. This type of discussion can be divisive and can easily lead to misunderstandings, animosity and unintended offense.

Political discussion directly related to ME/CFS is allowed.

So discussing NIH funding in relation to the role of the US President is fine. But commenting on the US President Elect personally, is out of bounds.

 

[Woolie]

Thanks, @mfairma. That was a really great explanation.

 

[Barry53]

... he appears to be talking about ...

The nub of the problem.

 

[lauluce]

There seems to be little way to tell how well a patient's metabolism, endocrine or immune system is functioning, unless these are broken in specific ways, let alone what is going on in their nervous system. These are the most fundamental questions in medicine, aside from the one of who pays the bills.

Well put! I always think about that... it seems to be an acepted fact of life that there´s no diagnosis or treatment for people with relatively minor symtoms like "mild" fatigue, pain or cognitive decline, results for current tests always come back normal, and the person is told he's healthy and he should go home... but the truth is there´s something causing those symptoms, we just don't have the technology to analize the anomalies that cause them. I've got full fledged ME, but my wife for example, after giving birth and going trought extenuous work and other hardships, ended up with non especific chronic symptoms such as reduced energy compared to her previous level, nausea, pain, etc... all those symptoms are far for bein ME, very far, but still she would like to get rid of them, but her "results" are of course normal, there is no answer for her, as there is no answer for anybody who began experiencing mild symtoms after sustained phisical and/or mental stress. But there should be an answer, I think we are perfectly capable of developing the science requirered, it's just that there's no interest in doing that
Sorry about my bad English, I'm not sure if I'm expressing correctly what I want to say. My question for all of you is, think about, say, a person who worked 5 years on the docks carrying heavy bags. This person ceases to work on the docks and instead starts to work at a confortable office job, no physical or mental stress. But even as the years passed and this person rests from his former job, his health is not the same, for he has just a fraction of the energy he has before he started working on the docks... the results of every currently avaiable test come back NORMAL of course. what happened exactly to his body??? did, for example, his energy producing systems deteriorated due to overuse? did he entered a permanent energy conservation state? this situation I describe happens all the time, but noone seems to be seeking the answer. what do you think?

 

[caledonia]

If Trump himself hasn't spoken about an issue, then you can look to the Republican party platform in general to get an idea of what would happen.

https://prod-static-ngop-pbl.s3.amazonaws.com/media/documents/DRAFT_12_FINAL[1]-ben_1468872234.pdf

The platform (page 7) states:

"As incubators of unconventional thinking, our country’s existing research infrastructure — the National Labs, the National Institutes of Health, NASA, and elements of the Defense Department — have the potential to form partnerships with small businesses to create an American Start-Up Century."

Increasing public/private partnerships could be good or bad. The CDC has a longer track record with this than the NIH. The CDC partners with many large corporations and insurance companies. It has caused corruption at the CDC.

The NIH also has a public/private partnership program which is newer, and which I believe has had less of a chance to become corrupt.

Many small businesses vs. large corporations could be good. Less chance of someone having large influence.

 

[Wolfiness]

I think we have a general problem when minorities start being scapegoated and people are viewed as burdens.

 

[anciendaze]

We have any number of problems @Wolfiness, but I don't think we are quite to the point where others will tolerate the idea of using mobile gas chambers to reduce cost of healthcare.

The new President, having never held political office, will be in for a crash course in checks and balances. He will learn that he cannot do much to increase revenue, that "power of the purse" lies in the house. He can sign treaties, but he cannot enforce them without Senate ratification. A wide range of his appointments require Senate confirmation. He will discover that the U.S. judiciary is surprisingly independent. This is important in a highly litigious country. (You might check on the amount of litigation related to medical expenses.)

On paper it looks like he has complete control after a seismic shift in politics. You need to remember that the label "Republican" does not guarantee him support. Even previous Republican Presidents left the top of their ballots blank to avoid endorsing him. Every single member of Congress comes with a separate agenda, even the nominal allies. Here's what his diehard opponents are thinking.

We are all about to learn a great deal about how the U.S. Constitution limits the power of individuals to damage the fabric of society. It isn't perfect, but then it wouldn't work if it were, with people as diverse, contentious and generally imperfect as Americans.

"You can always count on Americans to do the right thing - after they've tried everything else."

Winston Churchill