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 ) $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 )  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