Author + information
- S2452302X17300013-89b2715b071fdb6deae867f8826ef225Douglas L. Mann, MD, FACC∗ ()
- Center for Cardiovascular Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- ↵∗Address correspondence to:
Dr. Douglas L. Mann, Editor-in-Chief JACC: Basic to Translational Science, American College of Cardiology, Heart House, 2400 North Street NW, Washington, DC 20037.
“Science is science and facts are facts.”
—Donald Trump (1)
Donald Trump, who was elected as the 45th President of the United States, has been anything but predictable. Although a number of op-ed papers have been written recently in leading medical and scientific journals on the potential effect of a Donald Trump presidency on health care and science, none of these papers has discussed the potential ramifications of a Trump presidency for cardiovascular translational medicine. As we have noted previously in the Editor’s Page for JACC: Basic to Translational Science (2), translational science requires effective global cooperation between basic and clinical investigators in academia and industry, and is therefore extremely vulnerable to economic and/or political turbulence. Accordingly, it is appropriate to ask how a Trump presidency might affect the cardiovascular translational landscape. Spoiler alert: for those who read the title of this Editor’s page and were preparing to read a roiling, turbulent left- or right-leaning commentary on the 45th President of the United States, you can unbuckle your seat belt. Here, I will try to take an apolitical (to the extent that it is possible) look at 3 important ways in which a Trump presidency may affect cardiovascular translational medicine.
One of the most important areas where the new president can affect translational medicine, negatively or positively, is through his commitment to federal funding of science. Although Mr. Trump has pledged to cut federal spending, he has not proffered details on how this will affect funding for scientific research. The majority of academic translational researchers rely on grants from the National Institutes of Health (NIH). Historically, funding for these agencies has received bipartisan support, but has traditionally been higher under Republican administrations. However, as we have learned, Mr. Trump has never been a conventional Republican candidate, and he seems very unlikely to become a conventional Republican president. Mr. Trump’s tax cuts could limit near-term funding for research if the economy does not gain momentum as quickly as anticipated. Although the majority of decisions about funding and the direction of research are determined by Congress and the heads of government agencies, Mr. Trump’s picks for these agencies will be critical. The President has picked Representative Tom Price, an orthopedic surgeon and 20-year politician who served in the Georgia State Senate and the U.S. House of Representatives, to be his secretary of the Department of Health and Human Services. However, at the time of this writing, the President has not appointed his next science advisor, nor a new head of the NIH or the Food and Drug Administration (FDA). Choosing respected scientists for these 3 positions will be critical, and will provide some insight into how a Trump presidency will affect translational medicine. What we know about Dr. Price is that he is fiscally conservative and is an ardent opponent of the Affordable Care Act. However, he has also spoken in favor of increasing funding for federal research agencies, including the NIH, which he would oversee if he is confirmed by the Senate. Further, Dr. Price’s experience in both academic medical centers and private medical practice should make him sensitive to the numerous challenges that researchers are facing. Dr. Price, who will also preside over the FDA, will have the ability to pick a new FDA Commissioner or retain Dr. Robert Califf, who has only been in his post since March 2015. In our view, Califf has been an incredibly positive and rational voice for developing new drug and device therapies since coming to the FDA. President Bill Clinton retained David Kessler, who was appointed by the first President Bush, to continue to serve as head of the FDA when he became president. One can only hope that history will repeat itself and that Dr. Robert Califf will be retained as the FDA Commissioner, which will have an extremely positive overall effect on cardiovascular translational science.
The second area where a Trump presidency may affect translational research is immigration reform. Trump ignited the national debate on immigration reform with his campaign pledges to “build a wall” (along the U.S. border and Mexico), to deport all people who are in the United States illegally (including their children born in the United States), as well as to temporarily ban Muslims from entering the United States. These types of policies have the potential to threaten translational research programs in the United States, which rely on talented graduate and post-doctoral students from all over the world, as well as well-trained scientists from other countries. Currently, 5% of the students in the United States are from other countries, including >380,000 trainees who are engaged in studying mathematics, engineering, and science. The trainees and scientists represent an invaluable talent pool that helps to drive the engines of innovation in cardiovascular medicine. Avoiding a “brain drain” by retaining the scientists that train in the United States is critical to the field of translational medicine in this country. Campaign rhetoric notwithstanding, when candidate Trump was interviewed by sciencedebate.com on the question of whether he would support any changes in immigration policy regarding scientists and engineers who receive their graduate degree at an American university, he replied that: “The issues brought up in your question are exactly what we should be addressing in immigration reform. If we allow individuals in this country legally to get their educations, we should let them stay if they want to contribute to our economy. It makes no sense to kick them out of the country right after they achieve such extraordinary goals” (1). It will be extremely important to have Mr. Trump’s views on immigration reform clarified very early during his presidency. Uncertainty is never good for science or for scientists.
The third, and perhaps most important, area where a Trump presidency may affect translational research is how his administration’s policies will affect the biotech sector and the pharmaceutical industry. Mr. Trump’s pro-business stance could create a regulatory and tax-friendly environment that is supportive of the biotechnology sector, which may stimulate more investment and growth in this critically important area. When candidate Trump was interviewed by sciencedebate.com on the question of what policies will best ensure that America remains at the forefront of innovation, he replied:
“Innovation has always been one of the great by-products of free market systems. Entrepreneurs have always found entries into markets by giving consumers more options for the products they desire. The government should do all it can to reduce barriers to entry into markets and should work at creating a business environment where fair trade is as important as free trade. Similarly, the federal government should encourage innovation in the areas of space exploration and investment in research and development across the broad landscape of academia. Though 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” (1)
A Trump administration may also stimulate growth in the pharmaceutical industry, insofar as he has been less focused on the issue of drug pricing. However, Mr. Trump has, on occasion, advocated to allow consumers to import drugs from overseas, which could limit pharmaceutical profits as well as the dollars available for research and development. Although details are limited at the time of this writing, the Trump transition team has stated that the new administration will: 1) “advance research and development in healthcare”; and 2) “reform the Food and Drug Administration, to put greater focus on the need of patients for new and innovative medical products” (3). These policies would, in theory, be extremely advantageous for cardiovascular translational investigation.
Science is Science and Facts Are Facts
For the last 6 decades, over one-half of the growth in the U.S. economy has been driven by innovations in science and engineering. This largesse has engendered significant advances in cardiovascular medicine. When President Eisenhower was diagnosed with a myocardial infarction in 1955, he was placed in an oxygen tent at Fitzsimons Army Hospital, and was fed sausage, bacon, and hotcakes for breakfast; a hamburger with a raw onion for lunch; and roast lamb for dinner. Dr. Paul Dudley White, 1 of the pre-eminent cardiologists of that era, was roundly criticized by the cardiovascular community for truncating President Eisenhower’s mandatory 6 months of bed rest, to allow him to return to his work running the country. When former President Bill Clinton became symptomatic after 1 of his bypass grafts closed, he promptly had 2 drug-eluting stents placed, was discharged the next day on a high-dose statin, and then started a vegan diet. The tremendous strides that have been made in the treatment of cardiovascular disease have been the result of sustained and coordinated translational efforts by academic and industry partners. With the 21st Century Cures Act, formally enacted on December 13, 2016, we are now poised to make even greater advances in cardiovascular medicine. However, the next advances will require bipartisan Congressional support and an Administration that is committed to making health care great for all Americans. As always, we welcome your thoughts, and would ask you to share your opinions on the effect of a Trump presidency on translational medicine, either through social media (#NastyEditor #JACCBTS) or by e-mail ().
- The Author
- ↵Presidential Science Debate 2016. The candidates' views on America's top 20 science, engineering, tech, health & environmental issues in 2016. Available at: http://sciencedebate.org/20answers. Accessed December 31, 2016.
- Shah A.M.,
- Mann D.L.
- ↵Ramsey L. What we know so far about what a Trump presidency means for the drug industry. Science Business Insider 2016. Available at: http://www.businessinsider.com/trump-presidency-pharmaceutical-industry-2016-11. Accessed December 31, 2016.