Transcript Resource Allocation and Priority Setting at the NIH

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)
30000
$28,757,000 billion in FY2005
25000
20000
15000
10000
5000
0
1976 1979 1982 1985 1988 1991 1994 1997 2000 2003
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*
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.
*Numbers are from 1998 data
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