Hilary asked:

> ... how do we know what [NIH] money goes where? Do they issue some
> kind of financial report? Are they ever audited by some government
> or other authority. And who within the actual NIH decides on how
> the money is allocated? Are there committees? And if so, who
> serves on these committees? Do you need special qualifications?

A lot of information on this is available from NIH via their web
site www.nih.gov or from the Institute of Medicine report viewable
via the National Academy of Science web site www.nas.edu.  In a very
condensed form here is the process as I understand it, going all the
way back to the beginning:

Every January the President submits a budget proposal to Congress for
funding government operations in the following fiscal year, which
begins October 1.  The budget proposal for Fiscal year 1999, which
begins October 1, 1998, was submitted in January 1998.

As far as NIH goes, the requested budget amounts are supplied from
the NIH budget office.  They are broken down by major NIH
organization (Institute or Center), of which there are about two
dozen.  These include:

National Cancer Institute
National Heart, Lung & Blood Institute
National Institute of Dental and Craniofacial
National Institute of Diabetes, Digestive and Kidney Diseases
National Institute of Neurological Disorders and Stroke
etc.

PD comes under NINDS.  The amount for each of these organizations is
a line item in the budget.

Congress transforms the Budget proposal into major appropriations
bills, and in the process may make changes.  There is a House
version of the bill and a Senate version, and the House and Senate
may make different changes.  The House and Senate pass their
respective bills, and differences are resolved in a conference
commmittee of representatives of each body.  The bill which funds
the NIH is the Labor, Health and Human Services Appropriations bill.

This means that insofar as an Institute deals with a group of
diseases, it is Congress that has the final say on the overall
funding amount. But while some of the Institutes correspond to
specific disease groups (Cancer), others correspond to parts of the
body (Eye), to stages of life (Aging), or to something else (Nursing
Research). All the institutes fund more than one disease.  Also,
some diseases research may be funded by more than one Institute.

The NIH publishes reports of how much of the allocations by
institute are spent, and these are available via the NIH web site.
Also, I believe that there can be some shifting of funds by NIH
among institutes, but there is a limit to this.

Further breakdown of each appropriation amount is done by the NIH.
The next major breakdown is by research grant, R&D grant, training,
and facilities & construction. The NIH publishes reports broken down
to this level of how much is spent, and these reports are available
via the NIH web site.

The NIH has published their criteria for allocating the
appropriation amounts further, such as between basic research vs.
applied, or among different diseases, and this may be viewed via the
NIH web site as well. But it is not clear how the criteria are used.
The Institute of Medicine report described the decision process at
this level as "informal".  The NIH does not share with us the
justifications for allocations at this level.

At this level there are "programs of interest", which generally
correspond to diseases.  According to the Institute of Medicine
report, NIH has about 250 of these programs, of which about 50 are
reported annually, presumably to Congress.

At the bottom level of detail there are the specific grants. The
process and responsibility for deciding on which grants to fund are
well-documented and are available via the NIH web site.  Who got what
grant is also viewable there.  In brief, the decisions are made by
peer review groups, generally composed of university researchers, of
which there are several such groups for each Institute.  But there
mus be some prior allocation by review group, and I have not found a
description of this.

I hope this provides at least a partial answer to your questions.

Phil Tompkins
Hoboken NJ
60/9