Philanthropy and disease prevention: A long partnership

Philanthropy has long played a major role in the search for cures to deadly and debilitating diseases. From the dawn of modern medicine until World War II, philanthropists were the primary sources of funding for medical research. That role changed after the war, when science and technology became a national priority and the government began making massive investments in scientific and medical research.

For most of the past decade, however, the budget for the National Institutes of Health, the national funding source for medical research, has stagnated. While philanthropy cannot replace government funding, its importance has grown. From early stage research projects to efforts that turn basic findings into cures to studies that test whether treatments are effective, philanthropy plays a vital role in supporting the advancement of medicine.

Image Source: Federation of American Societies for Experimental Biology

The Numbers

• $32.3 billion is the budget for The National Institutes of Health in 2016.¹
• $2 billion was the increase over 2015, the first budget raise in more than a decade.²
• 20% is the amount that the 2015 NIH funding had fallen below the 2003 level after taking into account the rising costs of biomedical research.³
• $1.6 billion is the amount that wealthy donors from the Philanthropy 50, The Chronicle of Philanthropy's list of the nation's top donors, committed to medical research in 2014.⁴
• 5.5 percent is the increase of philanthropic giving to health organizations between 2013 and 2014.⁵

There in the beginning

One of the first major examples of philanthropic support for medicine was in the 1750s, when Benjamin Franklin helped pull together donors to fund the building of Pennsylvania Hospital, the country's first hospital.

More than a century later, philanthropy helped the field of medicine evolve from a craft with little standardized training into a scientific discipline. The field of microbiology was developed at the Rockefeller Institute for Medical Research, founded in 1900 by John D. Rockefeller. The institute launched campaigns to wipe out killer diseases and was the site of many breakthroughs, such as a vaccine for yellow fever.

In 1910, the Carnegie Institute contributed to the advancement of the field when it commissioned a report that advocated for medical schools to become more scientific.⁶

Stable government funding for medical research did not emerge in the U.S. until after World War II. Convinced by the war that sustained support of basic science was a national priority, political leaders dramatically increased funding to science and technology broadly.

The National Institutes of Health budget reflected this priority, growing from about $3 million in 1945 to $30 million by the end of that decade. The 1950 passage of the National Science Foundation Act further accelerated the government's funding role. The NIH annual budget increased to $300 million by the end of the 1950s and is now more than $32 billion.

Funding trends and philanthropic impact

After several decades of continued growth, the NIH budget remained relatively flat after 2005. Congress approved the first significant increase to the NIH in more than a decade in 2016. Because the budget has not kept pace with the rising costs of research, however, grants remain so competitive that many research projects are abandoned for lack of funding.

At the Yale Cancer Center, for example, less than 10 percent of applicants receive federal funding, down from a previous level of 20 percent, according to Dr. Patricia LoRusso, associate director of innovative medicine at the Yale Cancer Center.

As federal grants have become more competitive, they are more likely to go to established researchers. Private funding is therefore a lifeline to young researchers who have not built up a track record with the NIH, or those in the early stages of developing an innovative project with an eye for leveraging federal funding in the future.

"It's very rare that projects are funded the first time through the NIH grant process," said Melinda Irwin, Phd., Associate Director of Population Sciences. "With philanthropy, you can submit a grant and turnaround is a lot faster. It might be less money, but it helps answer questions that strengthen the grant application."

Philanthropy also supports research areas that are underfunded. The Gates Foundation has invested billions on the effort to eradicate malaria and tuberculosis, two diseases that primarily affect the world's poor. The Connecticut-based Stanley Family Foundation created the Stanley Medical Research Institute, which has invested more than a half-billion on causes of and treatments for bipolar disorder and schizophrenia.

While the total philanthropic contributions to medical research are not tracked, recent trends suggest they are growing.⁷ This has raised concerns that billionaire philanthropists are exercising too much influence outside of the established processes for setting national priorities. Because philanthropists are often motivated by something they or a loved one has experienced personally, there is a worry that disproportionate resources are being directed to diseases that primarily affect people of Northern European descent.⁸

Another concern is that basic science is being underfunded as philanthropy concentrates resources on translational research, those projects that apply the findings of basic science to the development of drugs and other therapies.⁹

Local impact

In New Haven, philanthropy has a long history of helping the Yale Medical School become one of the preeminent medical research institutions in the world. Two of the more prominent gifts were from John William Sterling (1844–1918), which led to the construction of The Sterling Hall of Medicine, and Joel and Joan Smilow, who helped fund the new Smilow Cancer Hospital.

It was at Yale in the early 1900s where Professor Ross Harrison made one of the century's greatest contributions when he pioneered the use of tissue cultures to study the growth of tumor cells. In the 1940s, Yale researchers developed the first chemotherapy treatments, administering the first cancer drug in 1942.

The Community Foundation, in its first year of active work, established a Cancer Control Committee in 1930 to lead a public campaign to attack rising cancer rates in the city. The committee began New Haven's first comprehensive data collection effort on cancer mortality rates. It also launched an education program designed to shorten the time between the appearance of symptoms and treatment. The committee's work culminated with a report published in 1935, which lead the state to pass special legislation creating a cancer division in the Connecticut Department of Health.

Cancer research has evolved over the years to its current focus on precision medicine. This approach to disease treatment and prevention takes into account genes, environment, lifestyle and other factors, and requires collaboration across several disciplines that typically rely on their own distinct funding streams from government programs.

Philanthropy, according to Irwin, helps break down silos by funding collaborative projects across departments and disciplines. At the Yale Cancer Center, foundations, the largest being the American Cancer Society, now account for roughly a third of the research funding, according to Irwin.

These new approaches to cancer prevention and treatment are offering hope. Mortality rates for all major cancer types have been falling since the 1990s. Continuing to make progress, Dr. Irwin said, requires ongoing research in all phases of scientific inquiry.

"You can't stop research once you've developed the drug. We may find a drug that works, but no one is taking it. We want to find out what it's like in a real world setting, taking it from the bench (the lab), to the bedside, to the community."

What The Community Foundation is Doing

The Community Foundation for Greater New Haven's long history of supporting cancer prevention and public health projects continues today through a variety of funds.

Recent grants include:

• Women's Health Research at Yale: A 2015 grant of $150,000 to support heart and cancer research that remedies the health disparities experienced by women, or by uncovering gender differences in health outcomes that benefit both women and men. In 2011-12, The Community Fund for Women and Girls made a two-year grant of $50,000 to WHRY for general purposes.
• Yale Cancer Center: A 2013 grant of $210,000 over three years by the Edith P. Rausch Fund to support the center's Pilot Projects Program to enable investigators to engage in innovative cancer research. The Anna and Argall Hull Fund provides about $150,000 annually to support fellowships offered by the Department of Pathology for work in the field of cancer research.
• The Lyme Connection: A 2016 grant of $15,000 was provided by the Elizabeth White Fund for Lyme to provide Connecticut residents with financial assistance for evaluation, diagnosis and treatment of Lyme and other tick-borne diseases from a doctor following the International Lyme and Associated Diseases Society guidelines.

Works Cited

1. "Budget | National Institutes of Health (NIH)." U.S National Library of Medicine. Accessed June 16, 2016. https://www.nih.gov/about-nih/what-we-do/budget.

2. United States. National Institutes of Health. Dept. of Health and Human Services. E Congressional Justification of the NIH Fiscal Year (FY) 2016 Budget Request. By Francis S. Collins, MD. Accessed June 16, 2016. https://officeofbudget.od.nih.gov/pdfs/FY16/Overview (Volume I).pdf. p.35

3. "Senate Panel Approves $2 Billion Raise for NIH in 2016." Science. 2015. Accessed June 16, 2016. http://www.sciencemag.org/news/2015/06/senate-panel-approves-2-billion-raise-nih-2016.