[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

                                 ______
                                 

                          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.

     

                          ____________________