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With lawmakers under increasing pressure to reduce overall federal spending, funding has been limited in many areas of health research and enforcement. Even before the recent focus on deficit reduction, funding for the National Institutes of Health (NIH) has been significantly constrained. In the 10 years prior to fiscal year 2008, the NIH budget grew by 31 percent, to $29 billion. From fiscal year 2008 through fiscal year 2011, the NIH budget grew by only 3%, to $30.6 billion (including a decline between FY 10 and FY 11 to $30.8 billion). In the most recent four-year period, competitive NIH grants were flat.

Cuts have occurred elsewhere in the public health arena as well. In FY 2011, the budget for the Centers for Disease Control was cut by $720 million and cuts look to be deeper in 2012. All predictions from federal budget watchers are for federal resources supporting health research to decline over the next 10 years.

These budget reductions have many implications, and leave us with much to consider. Everything from recent critiques of the FDA to challenges faced by HHS on implementing core functions can be connected to severely-constrained funding levels. In this post, I am focusing on one particular outcome of concern: the issue of conflicts of interest.

The New York Times ran an important and concerning article on the front page of its business section on November 3, 2011. The article described issues of conflict of interest facing several panels, which are developing guidelines for hypertension, cholesterol, and obesity. The Times reported that 20 of the 52 members of these panels—including co-chairs—have been instructed not to vote on crucial parts of the guidelines because of connections with industries affected by the guidelines. The connections include fees for speaking and consulting engagements, which have long been a source of concern in various federal health panels, and others involve industry funding for research.

These challenges are not new. There were scandals about this issue years ago, long before recent cuts in federal funding for research. And, the NIH goes to great lengths to identify conflicts of interest and minimize impact—through disclosure forms and other techniques designed to make the process transparent—but further limits to federal funding for health research will make it increasingly difficult to avoid conflicts of interest going forward.

Medical schools and schools of public health—institutions that have long relied on research dollars from NIH and other agencies to support core science and health innovations—won’t simply cut back on programs; they will look elsewhere for support. And with a shortage of public financing, it is likely they will turn to industry for funding. There simply aren’t a lot of other good alternatives. So, we shouldn’t be surprised to see candy makers or the soft drink industry becoming major sponsors of research on obesity at universities. Or to see the pharmaceutical industry funding guideline-connected research: research that then later causes concerns about the recommendations of federal panels on evidence based medicine.

In the end, we really can’t have it both ways. If we cut public financing, we have to understand the impact of that choice. With less public financing, other sources will be sought. And, just like in campaign financing, we might not like the end result we get.