Lobbyists Seek to Reslice NIH's Pie
Author(s): Eliot Marshall
Source: Science, New Series, Vol. 276, No. 5311 (Apr. 18, 1997), pp. 344-346
Published by: American Association for the Advancement of Science
Stable URL: http://www.jstor.org/stable/2893285
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EI NEWS&COMMENT
Lobbyists
Seek
to
Reslice
NIH's
Pie
Several organizations are complaining that they haven't been getting their fair share of NIH's budget
growth; NIHofficials say they are making simplistic and potentiallydamaging arguments
You might think this would be a year of ing that NIH justifyhow it divvies up the And the analysisignorescriticalthingsthat
harmonyamongthe loose-knitcoalition of fundingforvariousdiseases.Lastyear,Rep- can't be quantified,such as the judgmentof
groupsthat advocateincreasedfundingfor resentativeErnestIstook (R-OK), a mem- scientiststhat researchin a particularareais
subcom- ripeforexpansion.Varmus,spurredby legisbiomedicalresearch.After all, they have al- ber of Porter'sNIH appropriations
readyreceiveda sympathetichearingfortheir mittee,releasedgraphsputtogetherbyJames lators who have picked up the advocates'
number-onepriority:to doublethe budgetof Crapo,a well-knownpulmonaryresearcher logic,has decidedto counterit with a public
the National Institutesof Health (NIH) by andpathologistat DukeUniversity,indicat- educationcampaign:NIH staffershave been
2002. Senator Connie Mack (R-FL) sug- ing that majordiseasesarenot gettingtheir workingfor months on a pamphletthat is
gested this ambitioustargetin January,and fairshareof fundingincreases.In a subcom- supposedto explain NIH's method of alloleaders of the appropriationssubcommitcatingfunds.
ui
The increasingpressurefor targetedretees-Arlen Specter(R-PA) in the Senate
and John Porter(R-IL) in the House-say
searchfundinghas also put pressureon key
*
0
they like the idea, which would requirea
legislatorssuchasPorter-a championof bio15%increaseper year. Even if the real inmedicalresearchand an enemyof earmarking. Porter'ssubcommitteeand the Senate
creasefor 1998 turnsout to be closerto the
legislation,
panelthatwritesNIH authorizing
7.5%thatSpecterhasproposedasa plausible
6.
S.
_
. S
chairedby SenatorWilliam Frist (R-TN),
target,it wouldbe far more than any other
~~~~~~~~~~~~~~~~~~~~~~~~C
researchagency dreamsof getting. But, as
have now scheduledspecialhearingsto talk
diseaselobbiesbegintestifyingthisweekto a
abouthowNIH setspriorities.The Fristpanel
willmeeton 1May;Porter's
panel,on 13May.
Houseappropriations
subcommittee,thereis
An aide to Fristsays that the hearingwill
a sournote in the air-a threatof siblicide.
Foryears,biomedicalresearchadvocates
allow everyone to debate NIH's priorities
have had a rule that everyoneshouldclose
withoutaskingmembersof Congressto vote
ranksbehinda commongoal:to increasethe mittee hearing earlier this year, Istook took "thumbsup or thumbsdownon any amendoverallpot of moneyforbiomedicalresearch. up the subject again with a reference to the ment"fora specificdisease.The aim,he says,
But congressional aides and NIH staffers large sum NIH is spending on AIDS (see is to ventilatethe issuebeforevotingbegins.
say that severallobbygroups-in particular sidebar). Other legislators are using similar
the AmericanHeartAssociation(AHA), the logic to advance their own causes. Repre- Seeking a fairshare
JuvenileDiabetesFoundationInternational sentative Henry Bonilla (R-TX), for ex- In the weeks leadingup to those hearings,
(JDF),and advocatesfor Parkinson'sdisease ample, whose Hispanic constituency is af- Congresswill heardirectlyfromgroupsthat
research-are makingaggressivepublic ap- fected by a high incidence of diabetes, ar- believe they are being shortchanged.No
pealsfor a largerslice of NIH's pie for their gues that NIH should be earmarking more grouphas taken up the cudgelson its own
own areas.And while the leadersof these for diabetes research.
behalf more determinedlythan the AHA.
All this is putting NIH on the spot. NIH Lastyear,advocatesof heartresearchwereso
groupsdeny it, they appearto covet the $1.5
billion in NIH's $12.7 billion budgetspent director Harold Varmus calls such cost-per- aggressivein makingcomparisonsbetween
patient rationales "confusing"and "simplis- theirfieldandAIDS researchthat they drew
on HIV and AIDS research.
The Parkinson'sAction Network,forex- tic." He says the data come from different criticismfrom Varmusbehind the scenes.
ample, handedout a fact sheet on 9 April sources and are based on variable definitions. Varmussaysthathe hasmetwithAHA President Jan Breslow-a well-regardedheartcomparing NIH diseasebased expendituresin six
diseasegeneticistat RockefellerUniversityin
categories,alongwith a noNew YorkCityanda memberof the National
tice that a new bill was beAcademyof Sciences-and that "wehave a
Federally funded
Number
Research
... at this point."
ing introduced that day
muchbetterunderstanding
Disease
research
afflicted
$/affIicted
boosting Parkinson's reClaude Lenfant, director of the National
HIV/AIDS
$1,486,221,000
1,390,000
$1069
search. The sheet claims
Heart,Lung,and Blood Institute(NHLBI),
that in 1994, NIH spent
says he has also tried to temper Breslow's
Cancer
$295
$2,356,578,000
8,000,000
more than $1000 per afrhetoric.ButBreslowis as insistentas ever.
MultipleSclerosis $55,462,000
350,000
$158
at the detefectedpersonon HIV/AIDS
Breslowsayshe is "appalled"
Heart disease
$652,368,000
7,000,000
$93
riorationof supportforcardiovascular
studies
research,but only $93 on
Alzheimer's
$217,283,000
4,000,000
$54
heart disease and $26 on
overthe pastdecade,claimingtheyhavebeen
Parkinson's
$26,066,000
1,000,000
$26
Parkinson's(see table).The
"gutted"by neglect. "Thefield has been deBreslowsays,
implication was obvious.
pletedof younginvestigators,"
SOURCE: PARKINSON'S ACTION NETWORK
These argumentshave
andhe aimsto combatthe "myththat heart
been takenup by somecon- Mixed bag of numbers. The Parkinson's Action Network comdiseaseis going away."Breslowticks off the
servativemembersof Con- piled these data from a variety of sources to support its camnumbers:59 millionAmericansareafflicted
gress,who arenow demand- paign for a $100 million budget.
by cardiovascular
problemsor stroke,5 mil-
L
*
344
SCIENCE* VOL.276
*
18 APRIL1997 * http://www.sciencemag.org
AIDS: A Justifiable Share
AIDS advocatesoffer a harsherjudgment."The American
hearingon 26 February,Representative
At an appropriations
of
ErnestIstook (R-OK) askedwhetherthe National Institutesof HeartAssociationandothergroupsarepreyingon the prejudices
Health (NIH) had its researchprioritiesstraight.He suggestedto certainmembersofCongressto advancetheirownparochialgoals,"
the witness,NIH directorHaroldVarmus,thatNIH oughtto align saysGreggGonsalves,anAIDSactivistwiththeTreatmentAction
in
Group."There'ssucha cross-pollination
itsfundingdecisionsmoreclosely
1600 the worldof sciencethat lobbyingforspe- z
with health-carecosts. Citing a
0J
1400 - Tempting target.
cific diseasesis counterproductive."
smallstudyof Medicarespending,
Varmushimselfstaunchlydefendsthe cn
Istooknoted that NIH spendsa >1200 - Rapidgrowthin AIDS
spending is levelingoff.
relativelysmallpercentageof its .5
spendingon AIDS research.At the 26 2
Februaryhearing,Varmuspointed out to
dollars on diabetes and other
a 200
commondiseasesthatrackupbig
Istookthat AIDS is the country'sleading
causeof deathfor25- to 44-year-olds.And
Medicare bills. NIH research,
in a phone interview,he arguedthat the 0
complainedIstook,"isfocusedindisease should get special attention be- C)
steadon a diseasethat, although
causeit is new andstill spreading."We're
it is terrible,is not moreterrible
0
'81'82'83'84'85'86'87'88'89'90'91 '92'93'94'95X6'97 respondingto a publichealthemergency,"
than many other diseases,and
Year
addsWilliamPaul,headof the NIH'sOfcertainlydoes not representthe
samedegreeof threatto nearlyasmanypeoplein thiscountry...." fice of AIDS Research,whosaysthatforthis reason,AIDS should
At thatpoint,Varmuscutto thechase:"Let'stalkspecificallyabout be evaluateddifferentlyfromestablisheddiseases.
AIDS, becausethat'sobviouslywhat'son yourmind."
And ArthurAmmann,presidentof the AmericanFoundation
forAIDS Research,arguesthat AIDS shouldnot be comparedto
Istook'sthinly veiled attackon the AIDS budgetat NIHcurrently,about$1.5 billion is spenton the disease-mirrorsan diseaseslike cancerand diabetesfor a practicalreason:AIDS is
approachusedduringthe pastfew yearsby severaldiseaseadvo- causedbyan identifiedvirus,andhistoryhasshownthatvaccines
cacy groups(see main text). Some groupssay they deservea can stop such pathogens.'We put big resourcesinto polio, and
fundingallocation that correspondsto the size of their patient then therewasa vaccine,"he says.The sameis trueof manyother
population,noting that AIDS gets a largeallocation,while the infectiousdiseases.
Michael Stephens,a formerstaff directorof the House subnumberof HIV-infectedpeople is relativelysmall.
But manybiomedicalresearchleaderssay it is riskyto focus committeethat monitorsthe NIH budgetwho now consultsfor
attention on whetherspecificdiseasesget their fairshareof re- biomedicalresearchadvocates,says that even if the critics are
searchdollars.Anthony Fauci,head of the National Instituteof correctand AIDS is gettingmorethan its fairshare,the "distorAllergyand InfectiousDiseases,which gets mostof NIH'sAIDS tion is not radical."Stephenstakesa historicalview, arguingthat
funding, says he long has encouragedadvocacygroupsnot to AIDS researchis only following a pattem previouslyset by
lobbyCongressto increasefundingby diseasecategory."When cancer. After RichardNixon declaredwar on cancer in 1971,
youstartgettingjockeyingformoremoneyby constituenciesof a fundingforcancerresearchshot up, levelingoff in the '80s.And
certain disease,that, in the long run, doesn'thelp. Everybody now with AIDS, says Stephens, "the system is in fact sort of
benefits,"saysFauci,whenthe NIH budgetincreases"asa whole." settlingitselfbackdown."
-Jon Cohen
lion suffercongestiveheartfailure,and this
diseaseremainsthenation'snumber-one
killer.
Breslowplans to argue in testimony to
Porter'spanel this week that heart-related
research suffered "a serious shortfall"at
NHLBIand the National Instituteof Neurological Disordersand Stroke (NINDS)
duringthe decade when the AIDS budget
grew rapidly.The AHA claims that while
fundingforNIH overallhas increased35.9%
in constant dollars since 1986, the heart
programat NHLBI and NINDS declined
5.5%. Breslow is planning to ask that
NHLBI'sbudgetbe raisedfrom$1.4 billionin
1997to $1.65billionin 1998.Askedif AHA
is targetingthe AIDS set-aside,Breslowsays,
"We'renot tryingto takeanythingawayfrom
other diseases."Buthe insists:"Wearevery
upset that we have been neglected ... and
we'renot going to take it anymore."
The AHA isn'tthe onlygroupsingingthe
blues. The JDF is arguingthat diabetesresearch,too, hasbeen overlooked.The JDFis
pushingforspecialincreasesforthe institute
that chieflyfundsits area-the NationalInstituteof DiabetesandDigestiveandKidney
Diseases(NIDDK).It is usinga differenttactic, however-that of an eagerpartnerdemandingmoreattention.The JDFis unusual
in that it plansto donate$67 millionover a
decadeto projectsthatarepeerreviewed,coselected,and co-fundedby NIH.
On 1 April,JDFhiredRobertGoldstein,
an extramuralresearchdirectorfor immunology at the National Instituteof Allergy
and InfectiousDiseases,to be its own director of research.He is teamingup with the
managementfirm of McKinsey& Co. to
conduct a review of diabetesfunding and
developa strategicplanfordiabetes.JDFofficials say NIDDK fundinghas grownonly
53% in a 10-yearperiodwhen overallNIH
fundinghas increased97%.And Goldstein
saysthat whenparentsof a child with diabetes see these numbers,they ask, "Whyisn't
asotherpatients.
mychildjustas important"
http://www.sciencemag.org
The JDFwantsto increasefundingfor NIH
by 9%,forNIDDKby 12%,andfordiabetes
researchby 15%. Advocates have already
prepareddraftlegislationto mandatea national diabetesresearchplan.
Anothertargetedbill-the MorrisK.Udall
Parkinson'sResearchand EducationActwas introducedinto Congresslast week. It
wouldauthorizeNIH to spend$100 million
on Parkinson'sresearch(NIH now spends
about$32 million)andcreate10 specialcentersaroundthe countryforcollaborativeresearch.Morethan 100membersof the House
and 34 senatorsareco-sponsors.
And it's not just the arguablyneglected
who are out campaigning.On 8 April, the
NationalBreastCancerCoalition,whichhas
helped nudge hundredsof millions of dollars'worth of earmarksthroughCongress,
announced that it is forming a political
action committee.The purpose,sayscoalition presidentFran Visco, a Philadelphia
attorney,is to do "electioneering"-suchas
* SCIENCE * VOL. 276 * 18 APRIL 1997
345
registeringvoters-that is not permittedto
JoanSamuelson,leaderof the Parkinson's
regularnonprofits."We wanted to let our Action Network, adds that the more outvoting membersknowwho is reallysupport- spokendiseaselobbieshave set an example
ing us,"saysVisco.
thatothersarenowfollowing."Wewereselfsacrificing"wallflowersin the past,she says,
but "thediseasesthat have accumulatedthe
No more Mr.Nice Guy
It mayseemoddthatthisnew"targeted
advo- mostresearchsupporthavebeen verysinglecacy"is intensifyingwhile NIH's budgetis mindedabouttheirefforts.... That seemsto
increasing.Usually,coalitionsstart to frag- be the way to get the job done."And JDF's
ment when resourcesare declining. David representative
WilliamSchmidtsays,"There
Moore,govemmentliaisonfor the Associa- wasa time when we wereverygood citizens
tion of AmericanMedicalColleges,explains andreallywent up to the Hill with one mesthatafter"twoextraordinary
years,withhuge sage-overall [funding]for NIH. But it beincreases[forNIH],"more money has been comes hard as you see other disease areas
"pumpedinto the system,"but it hasn'tbeen advancefarbeyondwherewe are."Likemany,
distributedat the samerateto all constituen- these advocatesthink that politicalpressure
level makesgoodthingshappen.Or as Samuelson
cies.The result,he says,is an "increasing
of frustration,... someof it justified,"among says, "With enough money, [scientific]pothosewhofeelthattheyhavebeenleftbehind. tential can be createdin almostany area."
Varmussays."Money
Thatviewis"naive,"
is an attractant,but it's not sufficient.You
reallyhave to be convinced that there are
goodexperimentsto do."He plansto explain
at the upcomingHouseandSenatehearings
whyhe thinksscientificjudgmentworksbetter than political directivesin stimulating
research.NIH also hopes to spell out this
rationalein the publicreportit is preparing.
As for the growinglist of targetedresearchdemands,Varmussays:"Theway to
respond... is not to be defensive,butto have
a big workshop,have all the institutedirectors there, have the leadersin the field, ...
and see if we can identify new opportunities."In thatcase,advocacygroupscancount
on one thing at NIH: There will be lots of
big workshops.
-Eliot Marshall
ASTRONOMY_
Follow Up on Findings, Panel Tells NASA
A panelof astronomersis urgingNASA to programdirectorin NASA's Officeof Space
follow up quicklyon the field'srecent suc- Science, "[we]needed priorities... and we
cesses.Convenedby the NationalResearch neededthemon a fairlyshorttimescale."To
Council (NRC) at NASA's request,the 50- speedthingsalong,the NRCpanel,convened
memberpanel,chairedbyPatrickThaddeusol justa yearago,debatedresearchprioritiesin
space science only.
the Harvard-Smithsonian
Center for Astrophysicsin
At the top of the list for
z
Cambridge,Massachusetts,
the next 10 yearsor so, said
has urged NASA to give
the committee, is refining
priorityto space-basedina map of the microwave
background radiation. In
strumentsthat wouldbuild
on some of the most stunthe early 1990s, the Cosmic Background Explorer
ning feats of recent years:
the mappingof the cosmic
revealed tiny temperamicrowavebackground,
the
ture variations in this
uniform bath of microdiscoveryof galaxiesin the
waves-the imprint of priearly universeand planets
mordial "seeds"that grew
aroundother stars,and the
into great structures in
detectionof objectsthatare
almostcertainlyblackholes. Eagerlyawaited.The MAPmission today's universe. A finer
The panel,whichbriefed willchartdetails of the microwave scale map of these ripples
NASA space science head backgroundradiation.
would yield clues not just
to structure formation hut
WesleyHuntresson 8 April
and will formallypresent its report in a alsoto the densityandmakeupof the universe,
month, did not drawup a wish list of instru- Thaddeusandhis colleaguessay-implicitly
ments. Instead,it describedthe areasof sci- nudgingNASA to keep a plannedsatellite
ence that should receive top priority in called the Microwave Anisotropy Probe
NASA's spacescienceplans."Wepickedthe (MAP) on trackfor its August2000 launch.
science ideasthat have stayingpower,"says
The reportalsorecommendsfollowingup
Thaddeus.But its recommendationsgive a on recent spectacularsuccessesin finding
boost to severalmissionsthat arenow being galaxies near the time they were bom.
planned,fromnew gamma-ray
satellitesto a Bunnercalls it "strongendorsementfor the
[proposed]Next Generation Space Telesuccessorto the HubbleSpaceTelescope.
NASA askedforthe listbecausemostofthe scope and for a U.S. role in the European
projectsastronomersrecommendedin their FIRST"-the plannedFarInfraredandSublastpriority-setting
exercise,the so-calledde- millimeterSpaceTelescope.
While listingthe searchformoreplanets
cade reportissuedby the NRC in 1990, are
alreadyunderway.The next decadereport, aroundotherstarsas theirthirdpriority,the
which will list prioritiesfor both space-and astronomersalsourgesomerestraint,recomground-based
facilities,is not dueuntil 2000. mendingthat NASA hold off on tryingto
In the meantime,saysAlan Bunner,a science image planets like Earth. The planets curCO
346
SCIENCE * VOL. 276 * 18 APRIL 1997 *
rentlybeingfoundaregiants,the sizeofJupiter
or larger.NASA's proposed1998 budgetininterfercludesfindingfora small,space-based
ometer-a linkedarrayof telescopes-which
couldpickoutindirectcluesto planetsassmall
suchplanets,
asEarth.Actuallyphotographing
however,wouldrequirea large,costlyinterferometerpositionedout nearJupiter,a dream
thatThaddeussaysshouldbe deferred."First,
weshouldputourarmsaroundasmanyplanets
as we can,"he says,"beforedoing the very
difficultthingof findingterrestrials."
The final priorityhe and his colleagues
cite is measuringthe propertiesof black
holes-objects that have recently moved
fromthe domainof theoryto thatof observation. Bothstar-sized
blackholesandthe giant
black holes at the centersof some galaxies
triggerburstsof x-raysandgammaradiationas
theysuckin material.Bunnersaysthe recommendationthat NASA focuson the studyof
these objects supports the need for the
Gamma-Ray
LargeAreaSpaceTelescopeand
the High ThroughputX-raySpectroscopy
Mission,two proposedmidsizeprojects.
The astronomycommunityhasn'thad a
chanceto reactyet to the NRC committee's
assessmentof its field. But Bunner says,
"We'repleasedwith the process-it wasn't
cantankerousand it achieved consensus."
will
Whetherthesesciencerecommendations
guideNRC'snext decadereportis not clear.
"Thedecadeprocess,oncestarted,hasa lifeof
itsown,"saysJohnBahcallof the Institutefor
AdvancedStudy in Princeton,New Jersey,
who waschairof the previousdecadereport.
ButThaddeusis hopeful:"Isupposethe next
decade committeecould throw this in the
world,this
wastebasket.
Butin a well-ordered
wouldbe gristfortheirmill."
-Ann Finkbeiner
Ann Finkbeineris a science writerin Baltimore.
http://www.sciencemag.org