[Congressional Record Volume 143, Number 143 (Wednesday, October 22, 1997)]
[Extensions of Remarks]
[Page E2047]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICAL RESEARCH
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HON. LEE H. HAMILTON
of indiana
in the house of representatives
Wednesday, October 22, 1997
Mr. HAMILTON. Mr. Speaker, I would like to insert my Washington
Report for Wednesday, October 15, 1997 into the Congressional Record:
Setting Funding Priorities For Medical Research
The United States is the world's leader in medical
research. We spend more each year on research to cure and
prevent disease than any other nation, and we are also at the
forefront of developing new and innovative treatments for
diseases ranging from heart disease to breast cancer to AIDS.
The benefits of this research are manifest. Americans are
living longer than ever before, and we are much more
successful at fighting disease.
The federal government will spend about $13 billion on
medical research this year, which is 37% of the total amount
spent on research by all sectors. An important issue for
Congress, the medical community and average Americans is how
that money is spent. In general, Congress gives the National
Institutes of Health (NIH), the government's lead agency for
medical research, broad discretion in setting research
priorities, that is, in deciding how funding is allocated to
research on various cancers and other diseases. Congress has
earmarked money in recent years for specific types of
illnesses, such as breast cancer and prostate cancer. But by
and large, NIH is still the lead decisionmaker. This approach
is premised on the view that NIH, rather than Congress, has
the expertise to make the best professional judgments about
funding priorities and will make its decisions based on
public health requirements and hard science, not political
pressures.
Lobbying for research dollars
There is some concern, however, that this process is
becoming increasingly politicized. One measure of this change
has been the proliferation of groups lobbying the federal
government for research dollars. There are over 2,800
registered lobbyists on health issues, including 444
specifically on medical research. Lobbying on research
funding is not necessarily a bad thing. It can, for example,
bring attention to illnesses which have been underfunded and
otherwise provide decisionmakers with helpful information.
The question, though, is how far lobbying can go before it
undermines the integrity of the decisionmaking process.
Lobbying for research dollars is intense, with different
advocacy groups fighting for limited resources. The NIH
budget, unlike most agency budgets in this period of
government downsizing, has nearly doubled in the last decade.
It is nonetheless uncertain whether these increases can be
sustained under the recent balanced budget agreement.
Furthermore, competition for NIH grants is intense. About 75%
of the research grant proposals submitted to NIH do not
receive funding. Lobbying efforts appear in some cases to
have succeeded in shifting more research dollars to certain
diseases, particularly AIDS and breast cancer.
How funding is allocated
NIH-funded research is wide-ranging. It encompasses
everything from accident prevention to basic research on the
root causes of disease to research on specific diseases, such
as heart disease, diabetes and AIDS. NIH considers many
factors when allocating research dollars among various
diseases, including economic and societal impacts, such as
the number of people afflicted with a disease; the infectious
nature of the disease; the number of deaths associated with a
particular disease; as well as scientific prospects of the
research.
Congressional debate has focused on how NIH funds research
on specific diseases. Comparing funding levels can be a
tricky business. Research on one disease can have benefits in
other research areas. Likewise, funding of basic research may
not be categorized as funding for a specific disease even
though the basic research may be related to the fundamental
understanding and treating of the disease. Nonetheless, NIH
does categorize funding by disease area and, according to the
most recent statistics, it dedicates $2.7 billion to cancer
research, including $400 million to breast cancer research;
$2.1 billion to brain disorders; $1.5 billion to AIDS
research; and $1 billion to heart disease. Other well-known
diseases get lesser amounts. For example, diabetes research
gets $320 million, Alzheimer's research $330 million, and
Parkinson's research $83 million.
NIH critics say that these funding priorities fail to focus
on those diseases which afflict the largest number of
Americans, but rather emphasize those illnesses which get the
most media and public attention as well as the most effective
lobbying efforts. For example, the leading cause of death in
the U.S. is heart disease, followed by cancer, stroke and
lung disease. AIDS-related deaths rank eighth. A recent study
suggested that in 1994 NIH spent more than $1,000 per
affected person on AIDS research, $93 on heart disease, and
$26 on Parkinson's.
Conclusion
Congress has held hearings this year on how NIH sets its
funding priorities, and is now considering a proposal to
direct an independent commission to study the matter and make
recommendations on how to improve funding decisions. Others
have proposed more dramatic measures, such as having
Congress, rather than NIH, earmark funds or at least set
funding guidelines for the agency.
I am wary of proposals to involve Congress too directly in
the funding decisions of the NIH. Medical research involves
complex questions of science and technology, and Congress is
not well-equipped to make policy judgments in this area. I am
concerned that, if Congress took to micro-managing agency
decisions in this way, special interests would overwhelm the
process. Funding allocation should be guided by science and
public health demands, not by lobbying efforts or politics,
and the process used by NIH has been successful. Its research
has produced advances in the treatment of cancer, heart
disease diabetes and mental illness that have helped
thousands of American families.
I am, nonetheless, sympathetic to the view that the NIH
should give more attention when setting priorities to the
societal and economic costs associated with particular
disease areas. Setting funding priorities, particularly in an
era of tight Federal budgets, is a difficult process and
involves difficult choices. When NIH decides to emphasize one
area of research, it necessarily means less funding will be
available for other, worthy areas of research. The key point
is that the decisionmaking process be generally insulated
from political pressures.
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