Scientific Opportunities and Public Needs

Resource Allocation and Priority Setting at the NIH

NIH

27 institutes and centers Budget doubled in five years from

FY1999 through FY2003 Majority of research is in life sciences Receives more funding for R&D than

any other non-defense agency Does more basic research than any

agency

NIH Budget in Millions of Dollars (FY 1976-2005)

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1976 1979 1982 1985 1988 1991 1994 1997 2000 2003

$28,757,000 billion in FY2005

NIH budget doubled in five years from FY1999 through FY2003

NIH’s Criteria for Allocation of Research Funds Highest scientific caliber Best prospects for new knowledge

(research programs vs specific diseases ) Diverse portfolio (cannot predict major

discoveries) Public health need as measured by disease

burden Necessary infrastructure for research

Constraints Congress establishes separate

appropriations accounts for each research institute and center $80.5 million for NIEHS Superfund research $150 million for Type 1 Diabetes (PL-107-360)

Commitment base (funding decisions made in previous years limit $ available for new initiatives)

Advances in science are not a commodity and cannot be purchased by simple expenditure of dollars

(Preference:)NIH Roadmap for Biomedical Research New Pathways to Discovery, $137M

Generating new knowledge and building a better toolbox for researchers

Multidisciplinary Research Teams of the Future, $39M Awards for centers and training, support for

conferences Re-engineering the Clinical Research Enterprise, $61M

Facilitate rapid translation of discoveries from the lab to the clinic

Funds come from the NIH Director’s Discretionary Fund and the Institutes and Centers

(But:) Should Disease Prevalence Determine NIH $ Allocations? YES

Medical research fails to focus on diseases that cause the most suffering and death $1,129/heart disease death $723/stroke death $4,995/diabetes death $4,525/cancer death $31,381/HIV,AIDS death*

*Numbers are from 1998 data

Diabetes kills more people than AIDS and breast cancer combined every year, yet in 2003 the NIH research allocation is $3,053 on each patient reported to have AIDS versus $70 on each diabetic. Plus, the NIH is only spending $145 on each patient with prostate disease, $164 on each patient with Alzheimer's Disease, $398 on Parkinson's Disease, even thought all these diseases kill many thousands more than AIDS each year.

Should Disease Prevalence Determine NIH $ Allocations?

NO Earmarking substitutes political decisions for

scientific judgement Congress’ role is not micromanagement of

disease research Distribution of funds is not an adequate measure

of support for a specific disease (basic research is generally undirected)

Explicit directives may slow research by keeping funds away from areas of greatest opportunity

NIH Priorities (FY 2005) Recognizing the shift of disease burden,

increased focus on chronic diseases e.g. cardiovascular disease, stroke,

hypertension, cancer Expanding initiative on obesity Eliminating health disparities Protecting against lethal bioterrorist acts

through vaccines, diagnostics and therapeutics Strong focus on infectious diseases

SARS, West Nile Virus, influenza, malaria, TB, HIV/AIDS

Public Input at NIH

Advisory Committee to the Director NIH Council of Public Representatives