As a presidential candidate, Barack Obama promised to strengthen funding and improve coordination for biomedical research. Now, as he nears the end of his eight years in office, Obama's record is mixed.

Obama did sign into law a significant one-time infusion of research funding in the 2009 stimulus bill -- specifically, $10 billion for the National Institutes of Health, more than $8 billion of which went to research with most of the rest going toward construction, facilities and equipment.

However, the basic annual level of biomedical funding today is actually lower than it was before Obama took office, once you take account of inflation.

"The administration generally asked for decent increases most years, but Congress couldn't deliver because of the spending caps they put in place," said Matt Hourihan, director of the research and development budget and policy program at the American Association for the Advancement of Science. These across-the-board spending limits are officially known as sequestration.

Calculated using inflation-adjusted dollars, Hourihan said, funding for the National Institutes of Health in fiscal year 2016 was actually 3.4 percent below what it was in fiscal year 2008.

The impact can be seen in the "success rate" for funding new projects, Hourihan said. In 2008,  21.3 percent of applications were funded, but only 19.2 percent were funded in 2016.

It's worth noting, however, that in December 2016 -- at the very end of his tenure -- Obama signed the 21st Century Cures Act, a medical research bill that, against the odds given today's hyper-polarized congressional environment, passed with overwhelmingly bipartisan support. The House approved the measure, 392-26, while the Senate voted 94-5 in favor.

The 21st Century Cures Act promises $1.8 billion for cancer research funding, in memory of Vice President Joe Biden's son Beau, who died in 2015 from brain cancer. Separately, the bill directs $1.5 billion toward brain research, $1.4 billion for precision medicine, and $1 billion for improving drug treatment, particularly for heroin and opioid addiction. This funding will be allocated over seven years.

As for the other part of the promise -- to "improve the efficiency" of biomedical research "by improving coordination both within government and across government/private/non-profit partnerships" -- the biggest step in this direction remains the creation in 2011 of NIH's National Center for Advancing Translational Sciences. The center's mission is to "speed the delivery of new drugs, diagnostics and medical devices to patients" by developing "innovations to reduce, remove or bypass costly and time-consuming bottlenecks" in the biomedical-research pipeline.

Hourihan said this effort has remained a priority on Obama's watch. "Funding for that center has increased since its creation by over 11 percent," he said.

Overall, biomedical research funding has actually fallen during the Obama years, but the 21st Century Cures Act that Obama recently signed promises a substantial infusion over the next seven years, long after Obama himself is out of office. Meanwhile, the administration has given increasing funding to the main effort to improving coordination on biomedical research between the government and nonprofits. We continue to rate this promise a Compromise.

The stimulus was a boon for biomedical research. Outside of the stimulus, not so much.

During the 2008 presidential campaign, Barack Obama promised to "strengthen funding for biomedical research, and better improve the efficiency of that research by improving coordination both within government and across government/private/non-profit partnerships.”

First, let's look at the recent funding patterns for the National Institutes of Health, the federal government's main avenue for funding biomedical research. NIH funds several hundred thousand research positions at more than 2,500 public and private universities and research institutions across the country.

The stimulus allocated about $10 billion to NIH. Of that, more than $8 billion went to research. (Most of the remainder went to construction, facilities and equipment costs.)

The stimulus "was a very real, very large boost,” said Matt Hourihan, director of the research and development budget and policy program at the American Association for the Advancement of Science.

Still, the increase in the stimulus was temporary, and if you compare NIH funding in fiscal year 2009 to fiscal year 2012, the appropriated budget now is only about 2 percent higher than it was three years earlier.

This pattern held across the range of NIH's operations: Virtually every institute within NIH saw its budget increase by about 2 percent between 2009 and 2012, including such visible ones as the National Cancer Institute; the National Heart, Lung and Blood Institute; the National Institute of Allergy and Infectious Diseases; the National Institute of Mental Health; the National Institute on Drug Abuse; and the National Institute on Alcohol Abuse and Alcoholism.

"If you look only at regularly appropriated research and development funding and adjust for inflation, life-sciences research has basically been stagnant since 2009,” Hourihan said, adding that the Obama administration sought bigger increases, but Congress allowed only smaller bumps.

Meanwhile, for fiscal year 2013, the administration proposed the same amount of funding for NIH as in 2012.

Now let's look at the other part of the promise -- to "improve the efficiency” of biomedical research "by improving coordination both within government and across government/private/non-profit partnerships.”

The biggest step in this direction was the creation in 2011 of NIH's National Center for Advancing Translational Sciences. The center's mission is to "speed the delivery of new drugs, diagnostics and medical devices to patients” by developing "innovations to reduce, remove or bypass costly and time-consuming bottlenecks” in the biomedical-research pipeline. The center is partly designed to facilitate collaboration with organizations outside the government.

For instance, one of the center's initiatives is the Therapeutics for Rare and Neglected Diseases program, which is designed to move promising therapeutics into human clinical trials.

The Obama administration has made significant progress in both parts of this progress. However, the big spending boost from the stimulus is over (and unlikely to be repeated in the current fiscal environment). Overall, the NIH base budget has not kept up with inflation compared to its level in 2009, and the administration asked for flat funding for fiscal year 2013. On balance, we rate this a Compromise.

From stem cell research to fighting cancer and combating autism, Barack Obama made investing in medical research a key part of his presidential campaign. Since taking office, Obama's administration has modestly boosted federal funding and begun to build on data-sharing initiatives created during the administration of his predecessor, George W. Bush.

For the 2010 budget, the Obama administration sought a modest 2.1 percent increase in research funding for the National Institutes of Health, including $6 billion for cancer research and $141 million for research in the causes and treatments of autism. But the American Recovery and Reinvestment Act, or stimulus bill, was a windfall, including $1 billion for medical research within the Department of Veterans Affairs and $10 billion more for the NIH.

Patrick Clemins, director of the research and development budget and policy program at the American Association for the Advancement of Science, said the gains for medical research in the 2010 budget were slight, but reversed the trend: After big increases in the mid 1990s and early 2000s, research funding had not been keeping up with inflation in recent years.

While he's still crunching the numbers from the $3 trillion omnibus spending bill that Congress passed in December 2009, Clemins said he expects funding for NIH research to be slightly higher than the $32 billion that Obama requested. That's about $662 million more than in 2009.
While the increase from 2009 to 2010 was "pretty small, you really have to take into effect the (Recovery Act), which was a huge .. for most of those agencies" in the NIH, Clemins said.

As for the efforts to better coordinate research, the NIH in 2009 set up a national online Web site and database, www.ResearchMatch.org, to match people with potential clinical trials around the nation.

The Obama administration also is building on what the NIH started several years ago, according to the NIH. In January 2009, for instance, the National Center for Research Resources, part of the NIH, awarded $22-million to a center based at the University of Southern California that helps coordinate the sharing of data by researchers across the country.

While strengthening research funding and improving coordination among researchers will require an ongoing commitment, the Obama administration clearly has taken steps toward those efforts. Therefore, this promise is In the Works.