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New York Times
Research Investment Spurs Building Boom at Institutes of Health
November 1, 1998

By ROBERT PEAR

BETHESDA, Md.  --  The National Institutes of Health used to feel
like a bucolic college campus. Now it is a giant construction
project, with cranes and bulldozers erecting new laboratories, a
new research hospital and a new center for vaccine research.

   The activity here is the tangible symbol of a huge new federal
investment in biomedical research. Congress is providing far more
money than President Clinton requested because congressional
leaders of both parties have vowed to double the agency's budget
over five years  --  a process that began with the 1999 appropriations
bill, which just became law.

   The institutes have always enjoyed respect on Capitol Hill. But
lawmakers said they had increased the agency's budget more than
usual because they believed that researchers were on the threshold
of a new era. Discoveries in many fields  --  especially genetics,
neuroscience and cell biology  --  promise to save lives and transform
the practice of medicine in the next decade, they said.

   Congress provided $15.6 billion for the 1999 fiscal year, which
began on Oct. 1, up from $13.6 billion in the prior year  --  an
increase of $2 billion, or 15 percent. That rate of increase,
sustained and compounded over five years, would double the
institutes' budget by the year 2003.

   The 322-acre campus of the institutes is a beehive of activity
as construction crews reroute traffic, tear down trees, build new
roads and excavate a maze of underground tunnels to deliver steam,
water and electricity to the buildings.

   But scientists here receive just 10 percent of the agency's
budget. The rest is distributed to universities, medical schools,
teaching hospitals and private nonprofit research institutes. Most
of the money goes for basic research, to investigate fundamental
properties of genes and cells, or to test new methods of treating
diseases and disabling conditions. Among the priorities recommended
by Congress are mapping the human genome, preventing Alzheimer's
disease and finding better ways to detect ovarian cancer.

   Congress also provided $30 million this year for renovation and
construction of biomedical research laboratories around the
country. Sen. Tom Harkin of Iowa, the ranking Democrat on the
appropriations subcommittee responsible for the National Institutes
of Health, said he would seek much bigger increases for such
construction spending in the next couple of years. He is likely to
find allies among Republicans, including Sen. Arlen Specter of
Pennsylvania, chairman of that subcommittee.

   "The $2 billion increase for NIH is simply breathtaking," said
Donna Shalala, secretary of health and human services. "It's
extraordinary, the single largest dollar increase in NIH history."

   In his budget request in February, Clinton sought a more modest
increase, $1.14 billion, or 8.4 percent, which would have been
financed through an increase in tobacco taxes. But Congress never
approved the tobacco proposals.

   A congressional aide who works on the institutes' budget said
the big increase this year resulted mainly from lobbying by public
health groups and advocates concerned about specific diseases like
breast cancer, AIDS, diabetes and Alzheimer's. These groups work
closely with scientists and medical schools in lobbying Congress.

   "NIH stood on the sidelines," said the congressional aide, who
spoke on the condition of anonymity. "NIH didn't lobby hard for
this."

   In an interview last week, Dr. Harold Varmus, director of the
National Institutes of Health, said: "I'm a team player. We are
part of the administration, and we supported the president's budget
request. We don't have to advocate. We have advocates, very strong
advocates, in the disease groups and professional organizations."

   In the last two years, the institutes' budget grew an average of
7 percent a year, and with that money the agency was able to
prepare for the construction now under way.

   Clinton is directly responsible for one project, the five-story
vaccine research center, being built at a cost of $29 million. In a
speech at Morgan State University in Baltimore in May 1997, Clinton
declared a national goal of developing an AIDS vaccine within 10
years. Much of the work to achieve that goal will take place at the
center. Researchers there will also work on vaccines for other
diseases like malaria and tuberculosis.

   Varmus, who won a Nobel Prize in 1989 for his research on
cancer-causing genes, said he was pleased that Congress had
generally resisted the temptation to earmark money for specific
research projects at specific universities.

   The windfall comes just as the agency is trying to give patients
and ordinary citizens a bigger voice in setting research
priorities. The National Academy of Sciences gently chided the
agency this summer, saying it had not sought enough public comment
on these important decisions. Varmus said he was searching for ways
to "enhance public participation in NIH activities," as the
academy recommended.

   While Congress did not dictate precisely how money should be
spent in the new appropriations law, it did offer advice in a
report that accompanied the legislation. Over the years, officials
of the institutes have won the trust of lawmakers by closely
following such recommendations whenever they could.

   This year, for example, Congress urged the institutes to support
more research on progressive supranuclear palsy, a disabling
condition similar to Parkinson's disease; Behcet's syndrome, a rare
chronic inflammatory disorder, and brittle bone disease, an
inherited condition that leaves people susceptible to fractures
throughout their lives.

   The Senate Appropriations Committee initially earmarked $175
million for prostate cancer research, a cause of great interest to
the committee chairman, Sen. Ted Stevens, R-Alaska, who had surgery
for prostate cancer in 1991. House and Senate negotiators dropped
the explicit mandate. But their conference report says, "NIH is
strongly urged to make prostate cancer a top priority" and to
"accelerate spending" on the disease.

   Congress also urged the institutes to begin "a full-scale
initiative" to find ways of preventing Alzheimer's in people who,
because of their family history or other factors, are likely to
develop the illness.

   Over the objections of some government scientists, Congress this
year upgraded the status and authority of a small unit at the
institutes that studies alternative medicine, including
acupuncture, chiropractic care and homeopathic remedies. It also
urged Varmus to step up research on dietary supplements, including
the possible value of chromium in fighting diabetes, and it said he
should establish several new centers to highlight the benefits of
"mind/body medicine."

   When Republicans took control of Congress in 1995, they
skeptically scrutinized the institutes' budget and told scientists
to expect substantial cuts, as part of the Republican effort to
balance the federal budget. But Speaker Newt Gingrich of Georgia
and other Republicans have become strong supporters of the agency,
in part because they see it as an engine of economic growth.
Moreover, they say, research financed by the institutes is
extremely important to plant genetics and promises to increase the
productivity of seeds and agriculture.

   Carl Feldbaum, president of the Biotechnology Industry
Organization, a trade group, welcomed the big increase in the
agency's budget. He said many biotech companies had licensing
arrangements that allowed them to develop prescription drug
products using scientific discoveries made by the institutes and
its grantees. The companies pay royalties to the government or the
universities where the discoveries were made.

   "This is a partnership between government and industry that
really works," Feldbaum said. "It's the envy of many other
nations, to be able to take basic research and turn it into
therapies and cures."