[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Senate]
[Pages S12229-S12230]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              NIH EARMARKS

 Mr. COATS. Mr. President, I would like to speak today about a 
matter which concerns me greatly--the process by which funds are 
allocated at the National Institutes of Health (NIH).
  The National Institutes of Health is one of the finest institutions 
of medical research in the World. A commitment to providing the best 
possible health care has driven the NIH's recruitment of preeminent 
physicians and medical researchers across the breadth of the medical 
disciplines.
  Having created such an impressive resource, it is disheartening that 
Congress, through legislative earmarks and other mandates, often 
undertakes to second-guess the considered opinions of these experts.
  The practice of earmarking disease-specific funds results mainly from 
lobbying pressure directed to Senators or our staffs. As a result of 
this pressure, Senator's introduce language which sets aside sums of 
money--often very large sums of money--to be used exclusively for one 
specific disease.
  In September of last year, the Senate overwhelmingly approved the 
Department of Health and Human Services Appropriations Bill, which 
contained a provision for an in-depth study to examine the priority 
setting process at NIH. The amendment which incorporated this study was 
originally sponsored by myself and Senator Frist, and directed the 
Institute of Medicine (IOM) to conduct this study with utmost priority.
  The intent of this research was to understand how priorities 
regarding specific research programs are determined, how levels of 
funding for these research programs are established, and how new 
organizational entities within the NIH are created.

[[Page S12230]]

  This study grew out of Senator Frist and my concerns that Congress 
was unduly influencing the process by which priorities are set at NIH 
through the practice of the earmarking of funds for disease-specific 
research. We were concerned that the priority setting process at NIH 
was becoming less science-based and more politically drive. It was 
clear that our concern was shared by the majority of the Senate, as 
they voted to include this amendment in the appropriations bill.
  In July of this year, IOM completed its work and reported its 
findings to Congress. The study cited the need for greater public 
involvement, specifically, and I quote, ``The director of NIH should 
establish and appropriately staff a Director's Council of Public 
Representatives, to facilitate interactions between NIH and the general 
public'' and that, ``* * * public membership of NIH policy and program 
advisory groups should be selected to represent a broad range of public 
constituencies.'' unquote. It is interesting to note that both these 
recommendations focus public input directly to NIH, rather than to 
Congress.
  This is very much in line with another recommendation; quote, ``The 
U.S. Congress should use its authority to mandate specific research 
programs, establish level of funding for them, and implement new 
organizational entities only when other approaches have proven 
inadequate.'' unquote.
  The findings of this study are clear. For the purpose of priority-
setting, public input-including organized input via lobbying efforts--
are most appropriately directed to NIH, where it can be evaluated by 
appropriate science-based criteria. Only when there is evidence that 
NIH is unable or unwilling to apply this input appropriately to their 
priority-setting process and criteria, should Congress influence the 
process through legislative mandates. It is my contention that if the 
litmus test were applied to all earmarks, most would be stripped from 
legislation.
  The message is clear: Congress should avoid the practice of 
earmarking within NIH appropriations. The findings of the research 
conducted by the independent and impartial experts clearly indicates 
that the concern regarding the pricess of priority setting at NIH was 
warranted.
  As the Senate considers the future appropriations and authorization 
legislation for NIH, I would urge my colleagues to consider, with a 
critical eye, any disease-specific earmarks. I would urge my colleagues 
to ask themselves whether there is evidence that NIH has somehow failed 
to appropriately consider and apply science-based priority-setting 
criteria. In the absence of such evidence, I would urge my colleagues 
to not impose earmerks or other legislative mandates on the 
NIH.

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