President Donald Trump has called his fiscal year (FY) 2018 budget proposal a “blueprint for making America great again,” but oncological societies have been quick to denounce the budget plan, released Thursday, March 16, as a huge potential setback to health efforts in general and specifically to the fight against cancer. The budget proposal calls for a $5.8 billion cut—nearly 19%—in funding for the National Institutes of Health, which, through the National Cancer Institute, supports a significant amount of cancer research, including clinical trials, at independent institutions around the country. The NIH had a FY 2016 budget of $32 billion, and in the yet nonfinalized FY2017 budget the agency would receive $34 billion.

“We soundly oppose President Trump's budget outline,” ASCO wrote in a statement. Reducing NIH's funding … will devastate our nation's already fragile federal research infrastructure and undercut a longstanding commitment to biomedical science that has fueled advances in cancer prevention, diagnosis, and treatment.”

The budget proposal calls for dramatic cuts in various other types of health spending and is part of Trump’s plan to increase military spending by $54 billion next year largely by drawing from nonmilitary spending. The cuts if approved would leave the NIH with a budget of $25.9 billion and would involve a major reorganization of NIH institutes and centers to refocus resources on “the highest priority research and training activities,” according to the Trump budget plan. Among the changes, the Fogarty International Center, which fosters international global health research under the NIH umbrella, would be eliminated.

In introducing the budget plan, which cut spending in departments besides the NIH, Trump explained his priorities. “A budget that puts America first must make the safety of our people its number one priority—because without safety, there can be no prosperity,” Trump said. “…To keep Americans safe, we have made tough choices that have been put off for too long. But we have also made necessary investments that are long overdue.”

Trump said his blueprint increases defense spending without adding to the national debt, raises spending for immigration enforcement including resources for a wall on the border with Mexico and more law enforcement positions, and expands funding to fight violent crime and reduce opioid abuse.

In its strongly worded statement, ASCO contended the proposed cuts would gut the US research effort and drop the country out of its leadership role in cutting-edge medicine.

“When we are on the cusp of tremendous advances in cancer care, the United States can't turn back the clock on research that will benefit millions of Americans with life-threatening diseases and their families. Gutting the US research infrastructure won't make America First, but will decidedly place the United States behind other countries in scientific advances. Failure to nurture the historic US investment in research places health outcomes, scientific leadership, and economic growth at risk,” ASCO said.

Also speaking out against the proposed NIH cut was the American Society of Hematology (ASH), which noted that the NIH is the largest funder of biomedical research. “Robust federal investment in and by the agency has led to innovative bench-to-bedside discoveries that have resulted in paradigm-shifting advances in blood disease treatment and cures—from interventions that prevent stroke in young children with sickle cell disease to methods of engineering our own immune cells to attack tumors and beat cancer. In order to continue to make strides in conquering diseases, funding NIH at appropriate and sustainable levels must be a priority,” ASH said.

The proposal to cut the NIH budget comes just a few short months after former President Barack Obama’s administration announced a victory in achieving passage of the 21st Century Cures Act, which included a $4.8 billion special appropriation on 10 years for the NIH, part of which would go toward the Cancer Moonshot initiative to accelerate the pace of discovery and toward a precision medicine.

ASH said maintaining momentum of these endeavors is of vital importance. The organization noted that whereas Trump is working on the FY 2018 budget currently, the FY 2017 federal budget still has not been finalized, and ASH urged lawmakers to wrap up its appropriations bill before the current spending allotment expires in April.

“ASH is eager to work with Congress and the president to ensure that the budgets for 2017 and beyond are balanced between nondefense and defense programs,” the organization said. “Investments in both are necessary for sustainable, predictable funding that will fuel economic growth, reduce future health care costs, and ensure that the United States remains competitive, safe, and secure.”

The NCI received $5.21 billion in FY 2016, up $261 million from the previous year. The NCI issues grants for investigator-initiated research, clinical trials, and initiatives that address healthcare disparities. It also funds cancer centers and programs that help to “develop a strong workforce of cancer researchers,” according to its own description.

In the medical community, concerns have long been expressed that NCI funding for cancer research has been flat in recent years and actually on a decline when inflation is taken into account. From 2003 to the present, NIC funding has climbed from $4.5 billion to $5.21 billion in unadjusted funding. In 1998 dollars, the agency received less than $4 billion in 2003 and $3 billion last year, according to the NCI.

For a full description of the proposed budget changes, visit https://www.govinfo.gov/content/pkg/BUDGET-2018-BLUEPRINT/pdf/BUDGET-2018-BLUEPRINT.pdf

The Trump administration has given an aging military infrastructure as the reason for wanting to divert more funding in that direction. ASH said in its statement that it’s important not to go too far with that goal at the expense of other, worthy programs.