’21st Century Cures’ Leaves One Group With Empty Promises

Today, at 2 p.m. Eastern, the President will sign the 21st Century Cures Act—approved by the Senate on Dec. 7 by a vote of 94-to-5, overwhelmingly passed by the House the week before, and seemingly supported by every pharma company, medical institution, healthcare advocate and their mothers. And why not? “21st Century Cures” is the legislative equivalent of the Pee Wee League: In the end, there’s an award for everybody. (My colleague Sy Mukherjee has been all over the generous grab bag of provisions—here, here, and here—so I won’t go into the details now.)

But while this much-ballyhooed behemoth of a bill (nearly 1,000 pages) has been praised for being bipartisan, it’s also binomial: Technically speaking, “H.R. 34: the 21st Century Cures Act” is a “re-texted” version of “H.R. 34: the Tsunami Warning, Education, and Research Act of 2015,” which is intended to enhance and modernize the existing United States Tsunami Warning System. And the former isn’t exactly a “bill,” but rather an amendment to the latter—or, well, a House amendment to a Senate Amendment to the re-texted tsunami bill.

This procedural silliness, of course, is simply that: It’s just a little Congressional fun with words. But then, importantly, so is much of the 21st Century Cures Act.

Take, for example, the small chunk of the Act subtitled, “Supporting Young Emerging Scientists.” Here’s a very cool Permalink to take you right there.

The need to support young biomedical researchers is, frankly, an urgent one. As I’ve written about extensively in The Truth in Small Doses, it is harder than ever today for emerging scientists in the U.S. to get funding for their work, to follow independent research tracks, and to secure stable academic positions. As dismally low as success rates are for NIH grants these days, they are dramatically lower for younger scientists—and that’s slowing down science in a number of ways.

In 1980, new investigators got their first major NIH grant, on average, at age 36; today, the average age is 42. Back then, more than 40% of research project grants went to principal investigators (PIs) under 40; the share in 2016 is less than 10%. We now have more PIs age 66 and older than we do 36 and younger—and with this aging of America’s biomedical research force, we have put “a generation of science at risk.”

If all this sounds familiar, that’s because we’ve been singing this tune for a generation. In 1998, a distinguished committee led by Princeton University’s Shirley Tilghman warned that too many early-career life scientists faced diminishing and discouraging professional prospects. In 2005, another blue-ribbon committee—this one led by Nobel laureate Thomas Cech—said the situation was so dire for young American researchers that the U.S. was in danger of losing its “preeminent leadership position” in science. Three years later, another report, called ARISE, once again shouted the need to invest in early-career scientists.

All were substantive, well-researched reports that recommended substantive, well-researched fixes. So what does the 21st Century Cures bill do to implement them? It establishes the “Next Generation of Researchers Initiative” within the office of NIH Director to “promote policies and programs” that help young scientists. Gotcha.

Congrats, Congress—Collect your trophy after the game.