Beyond Clinton and Trump, Election Issues Ripple through Congress and into States

Voters will set the direction of research funding and issues ranging from drug costs to marijuana. [hermosawave/Getty]

Months of mud-slinging between Hillary Clinton and Donald Trump should finally, and thankfully, end in today’s election, setting the direction of biopharma research funding and other drug- and science-related issues for the next few years—as will Congressional races and state ballot questions.

At the tops of their respective tickets, both Clinton and Trump have committed in general terms to funding basic research—a path to which has been set by Congress through subcommittee votes in both houses.

In June, the Senate Appropriations Committee approved 29–1 a $2 billion (6.2%) jump in the FY 2017 NIH budget, to $34.1 billion. The following month, the House Appropriations Committee approved $1.25 billion more for NIH; both houses exceeded the 3% or roughly $1 billion increase proposed by President Obama in his nearly $4.15 trillion budget proposal, alarming advocates of higher research funding.

Support for higher NIH spending has been one of the few issues in Congress to generate bipartisan support, and should remain so no matter what happens to control of Congress after today. Polls and political watchers have agreed that the House of Representatives will remain under a Republican majority, though the 54–46 Republican Senate majority is likelier to erode or flip to a Democratic majority

“As President, I will work with Congress to ensure that government funding of research is sufficient to allow for multiyear planning, exploration of emerging research areas, and inflation-adjusted costs,” Clinton told ScienceDebate.org. “Funding is needed not only for the basic science research agencies and the large science and engineering mission agencies but also for the broader universe of agencies that are increasingly dependent on STEM for their missions.”

Trump has hinted that he would support higher NIH budgets despite his oft-repeated calls for cutting federal spending, telling ScienceDebate.org: “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.”

The comments of the major-party candidates have encouraged advocates for research spending: “There’s an infrastructure to science that’s creaky and needs attention, just like we have the built environment infrastructure with bridges collapsing and trains getting into wrecks and so forth,” Mary Woolley, president of Research!America, told GEN last month.

In two states, voters will decide ballot questions designed to raise funding for research by taxing cigarettes more—$2 in California and $1.75 per pack in Colorado, which will also add 22% more in taxes to other tobacco products.

California’s measure, Proposition 56, has been estimated to generate between $1 billion to $1.4 billion, according to the state’s Legislative Analyst’s Office, with 5% going to the University of California, toward “medical research into prevention, early detection, treatments, and potential cures of all types of cancer, cardiovascular and lung disease, and other tobacco-related diseases.”

Colorado’s proposal, called Amendment 72, would set aside 27% of revenue for tobacco-related research into cardiovascular and pulmonary diseases, cancer, Alzheimer’s disease, behavioral health, maternal health, and early childhood development. The measure has been projected to raise $315 million in its first year, of which 27% would be $85.05 million.

What Price Prescription Drugs?

The biopharma-related issue that has drawn the most public attention, however, has not been research funding, but the ever-rising cost of prescription drugs.

Clinton sent shockwaves through the biopharma industry and biopharma investors last year after Turing Pharmaceuticals and its then-CEO Martin Shkreli infamously raised the price of toxoplasmosis drug Daraprim 5000%, from $13.50 to $750 a pill. She proposed capping out-of-pocket prescription drug costs to $250 a month, allowing Medicare to negotiate drug and biologic prices, eliminating tax deductions for direct-to-consumer ads—and in an attempt at an olive branch to industry, lowering the exclusivity period for biologic drugs to 7 years from 12.

At the time, Clinton faced a strong primary challenge from Sen. Bernie Sanders (D-VT), who positioned himself in part as a staunch opponent of biopharma pricing practices and industry influence in Washington. Sanders opposed President Obama’s nomination of Robert Califf, M.D., as FDA commissioner, though Califf sailed to Senate confirmation by an 89–4 vote.

Trump has called for allowing Medicare to negotiate drug prices in order to contain sharp increases in patient costs, and even criticized the Daraprim increase, calling Shkreli “a spoiled brat.” Yet Shkreli, who was arrested in December 2015 on charges unrelated to Daraprim or Turing, endorsed the Republican candidate in May.

However, Trump has not spoken about drug prices as much and as vocally as he has called for repeal and replacement of the Affordable Care Act or “Obamacare,” in which patients have seen double- and in some cases triple-digit premium increases as numerous insurers have pulled out. Clinton has acknowledged the need to rewrite portions of the law.

Controlling rising drug prices is the goal of a ballot proposition pending in California. Proposition 61, the Drug Price Standards Initiative, would contain what the state spends on prescription drugs to that of the U.S. Department of Veterans Affairs, which generally commands the lowest prices. “This could be the shot heard 'round the world,” Sanders declared yesterday, during a rally supporting Prop 61. Biopharma industry entities have spent more than $109 million opposing the proposition, compared with the $18.5 million spent by supporters, according to The Los Angeles Times.

Another California ballot question, Proposition 64 or the Control, Regulate and Tax Adult Use of Marijuana Act, would legalize the possession, transportation, and purchase of up to 28.5 grams of marijuana for recreational use in California by adults ages 21 and older.

California is one of five states with ballot measures designed to permit recreational use of marijuana laws. The other four states are Arizona, Maine, Massachusetts, and Nevada. Voters in three additional states—Montana, Florida, and North Dakota—will decide whether to allow medical use of marijuana.

In a fourth state, Arkansas, one of two ballot questions allowing medical marijuana were disqualified by that state’s highest court. The remaining proposition, Issue 6 or the Arkansas Medical Marijuana Amendment, would legalize medical cannabis for 12 conditions, including cancer, HIV, hepatitis C, posttraumatic stress disorder, and Alzheimer’s disease.

No matter the outcomes, federal laws against marijuana will not change.