Medical community speaks out on effects of government shutdown

Janis L. Abkowitz, MD

As the world’s largest professional society concerned with the causes and treatment of blood disorders, many of ASH’s more than 14,000 members heavily rely on government funding, namely from the National Institutes of Health, to conduct cutting-edge research that results in better treatments and cures for millions of patients with blood diseases and cancer around the world.

As a consequence of Congress’s inability to pass a federal budget, our members — physician-scientists already reeling from sequestration-related NIH budget cuts — face additional uncertainty, since NIH has announced that it will be unable to process grant applications or offer grantee support during a government shutdown.

Over the last 10 years, NIH-funded research in hematology has transformed a once uniformly fatal form of leukemia into a disease managed by a daily pill, increased cure rates for pediatric leukemia, and led to the development of new blood thinners that can better treat and prevent strokes. However, continued progress is in jeopardy.

We simply cannot afford to place lifesaving biomedical research on hold on account of congressional bickering. As Congress continues efforts to pass a fiscal year 2014 budget, we urge lawmakers to recognize the value of biomedical research and support a balanced approach to deficit reduction that does not include further cuts to NIH.

Samuel Silver, MD, PhD

For the hem/onc community in general, the government shutdown has had fairly little effect in terms of day-to-day practice issues. Claims from Medicare and Medicaid are continuing; however, there is a concern about claims in Washington, D.C., due to the unique relationship the District of Columbia has with the federal government. There may be claims issues for patients in the District.

One of the two things that are of major concern is that the fact that the NIH is no longer processing new grant requests. Unless this is resolved relatively quickly, there will be major issues funding research. Enrolling people into research studies has been fairly difficult — if not impossible — at the NIH, which has been fairly well publicized in the press. Admitting new patients to the inpatient service at NIH, I believe, is becoming very difficult, as well. These are areas of major concern in terms of advancing research, especially surrounding the NIH/NCI and the processing of grants or bringing new patients on for intramural clinical trials.

The government shutdown has also closed operations of the Congressional Budget Office. The area that gives information to congressional committees for bills is no longer able to take a look of those bills for analysis of fiscal issues. We’re once again coming down to the wire for SGR. Certainly, Congress has been diverted from consideration of SGR reform because of the Affordable Care Act and government shutdown. Congressional staff is not working on SGR reform language, and this is exacerbated by lack of Congressional Budget Office analysis. So are we headed for another Dec. 31 showdown for what’s happening with SGR, as we have every year for the last decade? This year was supposed to be different, but it looks like it’s going to be no different, and may be worse.

Last week, at a meeting of the AMA/Specialty Society Relative Value Scale Update Committee (“The RUC”), CMS representation was notably absent because of the government shut down. The AMA formed the RUC to act as an expert panel in developing relative value recommendations and practice expense inputs to CMS. CMS has always had a seat at the table, and the dialogue between CMS and RUC members is very important in guiding recommendations to CMS. CMS, for the first time, was not at the table, and this important dialogue  did not occur. It is difficult to say what impact this will have, but in these increasingly uncertain times, it certainly will not help.

Donald L. Trump, MD, FACP

Shutdown on top of sequestration, which is exacting real reductions in support for important research, will substantially limit the support our cancer center will receive for the next 5 years as sequestration impacts base-year grant request calculation. This is another blow to the cancer research community that may well result in delayed and missed opportunities to improve the understanding and treatment of cancer. Cessation of the deliberative processes whereby grants and contracts are reviewed and awarded will slow progress, and even slowing of a week or two could make a difference.

Jed B. Gorlin, MD

I heard on NPR that the NIH is unable to enroll new patients on clinical trials, which has a direct adverse effect on both research and potentially patient care.

Amusingly, my blood center was in the middle of an FDA biannual inspection, which is now on hold as the FDA staff are furloughed. In fact, it would have been preferable to be able to complete the assessment, as it is disruptive to staff here as well as the FDA personnel.

I assume that the FDA approval process for new medications, blood products, and blood screening and treatments are all on hold until the government funding crisis is resolved.

Clifford A. Hudis, MD, FACP

The country woke up [Tuesday] morning to the first government shutdown in 17 years. This is a sad state of affairs, and we must insist that — moving forward — our elected leaders do better to ensure that millions of Americans with cancer can continue to rely on their government for essential cancer care, life-saving research, and the advancement of safe and effective drugs into practice.

The short-term impact on clinical and laboratory research was felt first thing [Tuesday] when investigators were notified that the federal agencies that are critical to ongoing and planned clinical research would not be available until further notice. However, it is the long-term disruption to government services that could be even more devastating to research innovation and the overall health of the nation for decades to come.

We call on Congress and the administration to work together to pass a budget that will continue our country’s commitment to individuals with cancer. Millions of lives, scientific progress, and our worldwide leadership depend on their action.

David May, MD, PhD, FACC

It’s impossible to tell if [the shutdown] has had an effect at this particular point. It will, without question, impact cardiovascular research if it continues. There are trials that are not being funded. There are issues regarding children’s research initiatives that have been put on hold. In the land of research, most of those projects are ongoing for long periods of time, so a brief period — like we hope this will be — will not have a material effect long-term, but it will certainly be disruptive during this period of time when they have the shutdown. Those programs that are federally funded will be considered discretionary and put on hold. I don’t know if the employees themselves would be sent home, but certainly we would stop enrollment in those types of programs for the period of the shutdown. 

Alan J. Garber, MD, PhD

I don’t think we have any unique issues in endocrinology compared with other cognitive specialties such as infectious disease or hematology.

The problems with government shutdowns are, of course, the result of not paying their bills. In an office-based practice such as endocrinology, there’s a high overhead cost, which has to be met week by week. If a third of patients are Medicare- or Medicaid-paid patients for whom reimbursement is late or not forthcoming, then these offices will have to meet their overhead from other sources and hope to recover those funds later. The cost of carrying these unpaid bills is never repaid.

I don’t see any reason it should affect our patients; the real problem is with research. So much of modern academic medicine is dependent on government-funded research that I don’t know what they’re going to do.

It seems to me the problem is beyond what we [as physicians] can advocate for. It’s a situation where the aims of the political process have become more important than the welfare of the country. As a result, there is posturing for the political benefit of the individual representatives or senators that is unrelated to the good or the ill of the country and it’s a fundamental transformation of the government. It used to be — at a time I can remember in my own lifetime — that the welfare of the country always came first. Now it’s party first, country second. This is equally true on both sides. The attempts by one side to lay blame at the feet of the other side are pretty futile here.

The current impasse is also a political commentary on passing major legislation through a one party super majority where the other side has no input whatsoever. You invite this kind of sniping later on because the other side never got a chance to buy into it or have input. You can’t do that in medicine. You can’t treat patients that way. You can hardly handle politics that way.

I think we endocrinologists need to tend to business and ignore Washington. There will always be the Chicken Littles of the world who insist the sky is falling. Yet, somehow it never does.

Margery Gass, MD

Abruptly discontinuing a funding source has the potential to seriously derail important research; that is an unfortunate and unnecessary waste of time, energy and taxpayer dollars.

James Campbell Quick, PhD

The key effect [the government shutdown] will have on mental health professionals is awareness that their patients are going to feel threatened by the shutdown, and that their stress and anxiety levels are probably going to go up a good deal. That is very understandable in light of the circumstances that these patients have literally been thrown into; psychiatrists, psychologists and social workers are going to be in a place where they need to be aware of that and be ready to support and catch and frame the reality of the circumstances for these people. Psychiatrists will be a critical resource for patients.