An Endocrine Society Position Statement
A half century of investment by the United States Federal Government in biomedical research has dramatically advanced the health and improved the lives of the American people. Funding for the National Institutes of Health (NIH) specifically has had a significant impact on the United States’ global preeminence and development of a biomedical research enterprise that is unrivaled throughout the world. Biomedical research entails understanding how the body works and investigating how to enhance health and reduce disease. A vital field of study for understanding human health is endocrinology, which involves the investigation of hormones and the role they play in the body’s daily function. This includes research to help us understand how changes in hormones contribute to disease. Basic and clinical endocrine scientists funded by NIH conduct research that leads to the development of treatments for endocrine disorders and diseases including diabetes, some cancers, obesity, thyroid disorders, and infertility. These conditions affect millions of people in the US and create a significant health and economic burden on society. The development and discovery of treatments for diabetes, obesity, cancer, cardiovascular disease and others are available today thanks to NIH funding.
The NIH is comprised of 27 institutes and centers and annually invests more than $35 billion in extramural research funded throughout the country.1 More than 80% of the NIH’s funding is awarded through over 55,000 competitive grants to more than 300,000 researchers at over 2,500 universities, medical schools, and other research institutions around the United States and throughout the world.2 There is no single NIH institute focused on endocrine research. Instead, clinical and basic endocrine-related research is supported though at least 18 different NIH institutes and centers such as the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, National Cancer Institute, and National Institute of Environmental Health Sciences.
Federally funded biomedical research is supported primarily through annual appropriations to the NIH and provides opportunities to conduct foundational and translational research that is not performed in the private sector or other government agencies. NIH-supported discoveries help inform research and development (R&D) for private sector companies. Congress has historically shown bipartisan support for biomedical research by increasing the NIH budget. From 1998 to 2003, the Congress committed to double the budget of the NIH from $13.6 billion to $27.3 billion. However, this was followed by a period of stagnant growth for the agency. Then, from FY 2016-FY 2023, the NIH saw funding increases each year with bipartisan support, with the FY 2023 budget reaching $47.5 billion.3 Despite this support, NIH funding has not kept pace with inflation as the FY 2024 appropriated funding level for NIH has not achieved considerable growth in real terms relative to Fiscal Year (FY) 2003 funding levels.1 Under a year-long continuing resolution, FY 2025 appropriations are stagnant. Biomedical research should be protected and funded at the highest possible dollar amount to support continued growth. Illegal impoundments of appropriated funds for biomedical research should be reversed. Without appropriated funding that accounts for inflation and confidence that appropriated funds will be spent as intended, the opportunities to discover lifechanging cures and treatments will drastically decrease. The funding uncertainty also threatens the future research workforce as funding uncertainty has caused some graduate programs at U.S. institutions to reduce admissions for the next academic year.4 This will create gaps in the biomedical research and public health sectors that will threaten Americans’ health and well-being and will prevent the U.S. from maintaining its global research leadership and economic competitiveness.
While NIH has received funding increases in recent years, these increases have struggled to keep pace with inflation. For example, the NIH’s FY 2022 purchasing power was only 0.6% greater than the FY 2003 level.3 As a result, the NIH budget cannot sufficiently fund many of the highly meritorious research grants received from investigators and scored highly during peer review. Furthermore, illegal impoundment of appropriated biomedical research funding will impact ongoing research projects, preventing the generation of new data and discoveries to improve public health.
Impact on the national, regional, and local economy
Funding for biomedical research fuels the local, regional,
and national economy. For every $1 invested in NIH funding,
there is a $2.56 return on investment. This means that the
$36.94 billion awarded to NIH scientists in FY 24 lead to
$94.58 billion in economic activity.1 NIH funding supports
basic, translational, and clinical science, ensuring that the
discoveries made in the laboratory translate to treatment
options for patients suffering from debilitating and lifethreatening
diseases. Advances in treatment also reduce
the health care costs of our nation. As the population of
the United States ages, the incidence of costly, chronic
conditions such as diabetes, obesity, cardiovascular
disease and cancer, will significantly increase. To save the
country billions in healthcare costs, additional investment
in biomedical research will be needed. Studies on the
effectiveness of investing in research has identified
significant savings on health care: for instance, treatments
that delay or prevent diabetic retinopathy save the country
$1.6 billion a year,5 and prevention programs that reduce
the risk of developing type 2 diabetes can result in a net
savings to Medicare of $2 billion over 10 years.6 Global
competitiveness and leadership in science and the economy
NIH investments have approximately a 2.5x return on investment for the United States and supported over 400,000 jobs.1 Without the release of appropriated biomedical research funding and an increase in funding for NIH for FY 2026, the United States economy will be significantly impacted. In addition to the impact that research has on the country’s health care spending, research funding also has a positive impact on local economies by supporting the development of new, high-paying jobs. FY 2023 NIH funding created over 400,000 jobs in the US.1 In Los Angeles, each dollar of taxpayer investment received by the University of California Los Angeles, generates $21 in economic activity, resulting in a $16.6 billion impact on the region.7 In Alabama, $380 million in NIH grant and contract funding directly supported over 4,000 jobs and spurred $916 million in economic activity.8 The jobs created by federal dollars directly impact those conducting research, and also support staff who operate “core” research facilities that provide specialized resources for numerous labs, administer grant submissions and compliance at universities, and many others that directly or indirectly support the research enterprise. Without federal research investment, the revenue injected into local and regional economies would be lost. Not only does this significantly impact individuals directly involved in research, but it also affects industries that depend on downstream revenue.
Global competitiveness and leadership in science and the economy
Bolstering research funding is imperative for the success
of the US biomedical research enterprise and leadership
in the global economy. US R&D expenditures relative to
the global share of R&D has declined over nineteen years
from 37.1% in 2000 to 27.3% in 2019.9 As the amount
of federal research funding remains flat or begins to
decline, so do the opportunities for the US to maintain its
leadership and competitiveness in R&D globally. A decline
in funding can translate to a depletion of America’s pool of
scientific talent, thereby reducing the US’s ability to drive
discoveries and innovation in all sectors of the economy.
A 2024 survey conducted by Research!America revealed that public sentiment supports federal funding of research as 73% of Americans feel it is very important for the US to be a leader in medical and health research.10 In 2020, 61% Americans say current spending on research to prevent, cure, and treat disease is not enough.11 In fact, in the 2023 survey, 63% of Americans say they are willing to pay more in taxes in support of health research.12 These survey data highlight the need for policymakers to prioritize investments in research to maintain the country’s global leadership.
Increased longevity and improved quality of life
Federally funded endocrine-related research has resulted
in significant advances in the prevention and treatment of
some of the nation’s most prevalent diseases at a fraction of
what it would cost to manage these conditions. For instance,
NIH-funded studies have found that in post-menopausal
women, one of the best predictors of fracture is bone mineral
density of the hip. This finding resulted in a better method
for identifying those at risk for osteoporosis, which in turn
prevents expensive and debilitating fractures that cost
$17 billion annually in direct care.13 Another impact of NIH
research is focused on the management of Type 1 diabetes
(T1D), which affects 1.6 million adults in the US. People with
T1D cannot make insulin and must rely on external sources
of insulin to survive. Monitoring insulin levels and when and
how much to dose can be complicated for users, particularly
children. To address this, NIDDK supported researchers who
developed a device known as a “bionic pancreas”, which
uses next-generation technology to automatically deliver
insulin to those with T1D.14 Not only is the bionic pancreas
more effective at maintaining blood glucose levels, it is also
easier to use and leads to improved quality of life. This was
made possible not only through funding of this project,
but also through sizeable investments in basic research in
the decades prior to establish the mechanism of how T1D
leads to dysregulation of blood glucose levels. Additionally,
studies conducted by the NIH have found that with intensive
lifestyle intervention, a patient’s risk of getting type 2 diabetes
can be reduced by 58%, and that the drug metformin
can reduce the development of diabetes by 31%.15 These
interventions in improve quality of life for those living with
diabetes and reduce associated health care costs. Diabetes
affects 11% of the entire US population, and $1 out of
every $4 in US health care costs is spent on care for people
with diabetes.16 However, if funding levels for biomedical
research do not keep pace with inflation, breakthroughs in
medical care to address this need will never be realized.
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