More than 20 million Americans live with kidney disease, a devastating disease that can lead to kidney failure or end-stage renal disease (ESRD). Most of the 650,000 patients with ESRD are stuck on dialysis because there aren't enough donated kidneys for everyone who needs a transplant, the optimal form of treatment.
Most dialysis patients require three treatments every week for three to four hours at a time, which is both emotionally draining and physically exhausting. Because kidney disease is often associated with other chronic conditions, such as heart disease, diabetes, hypertension and stroke, dialysis patients juggle many other doctor appointments and are frequently admitted to the hospital. Not surprisingly, only 1 in 5 dialysis patients work, and many receive Social Security Disability Insurance benefits.
Moreover, ESRD—the only health condition that Medicare automatically covers regardless of age or disability—represents 7 percent of Medicare's cost but less than 1 percent of the patient population. At $35 billion annually, the Medicare ESRD Programs costs more than the entire budget of the National Institutes of Health (NIH), and for a treatment with grim outcomes. Fifty percent of patients die within three years of initiating dialysis, and most patients die while waiting for a transplant.
Research to prevent the progression of kidney disease or improve the care of patients with ESRD, will also have the effect of reducing heart disease and other chronic conditions and yielding significant Medicare and Social Security Disability Insurance savings. This research, however, is largely dependent upon sustained and steady increases in NIH's budget, particularly for groundbreaking basic research, the building block for new treatments and cures.
Dr. Benjamin Margolis, a nephrologist at the University of Michigan, is one of the leading investigators in the basic science of kidney cells. His discoveries and research program have been critical for understanding how these cells are organized, and consequently for bettering our understanding of how these cells work.
Dr. Margolis had been an investigator in the Howard Hughes Medical Institute for 10 years, and had published many papers in top-ranked journals, but he lost NIH funding for his research in 2014. Although he was able to get some research support from the university, this highly productive investigator and his research program were shut down due to lack of funds.
Two highly promising young faculty researchers who were mentored by Dr. Margolis also lost the opportunity to continue their research with Dr. Margolis, despite having their own career development awards from NIH. Other highly productive members of his laboratory were also suddenly without a job. The research that Dr. Margolis and his lab were conducting has made significant contributions to the understanding of polycystic kidney disease—which affects an estimated 12.5 million people worldwide, and is one of the most common genetic diseases in the world.
This scenario is not uncommon. Highly productive senior investigators like Dr. Margolis are being forced to end their research careers because of research funding cuts. While disruptive and discouraging to senior investigators, the impact on junior investigators is barely imaginable. They see their mentors, who are often leaders in their fields, being forced to end productive research programs.
The takeaway for the next generation of researchers is that careers in fundamental biomedical research are impossible. After all, when their heroes can't succeed, how can they imagine success? The greatest tragedy is not that Dr. Margolis had to lock the door to his research laboratory, but that current and future trainees will now not even try to open the door to a biomedical research career.