 |
 |
I wonder if the author, Mr. Greenberg, has ever had a need to "rattle his cup",begging for care that is rightfully his?? The Lancet,Volume 349, Number 9060 - Saturday 26 April 1997 http://www.thelancet.com/lancet/User/vol349no9060/news/index.html#newsin WASHINGTON NIH resists research funding linked to patient load=20 In the politics of biomedical research here, the challenge of the season for the managers of the National Institutes of Health is to fend off rising pressures for what they derisively refer to as "body-count budgeting". The term, spawned by biomedical lobbying, refers to allegations of a mismatch between the number of patients afflicted by a particular disease and the proportion of the NIH budget devoted to research on that disease.=20 When the arithmetic has suited their purposes, the "disease-of-the-month clubs" that surround NIH have always grumbled about what they regard as inequities. But a sense of gross injustice has been fostered by the meteoric growth of funds for AIDS research--from US$200 million in 1981 to $1=B75 billion this year. On a per-patient basis, according to NIH accounting, that works out to $2403 per HIV case, while diabetes and heart disease each rates about $20 per patient; Alzheimer's disease, $78; and breast cancer, $209. 2 weeks ago, advocates of increased spending on Parkinson's disease rallied on Capitol Hill in support of legislation that would nearly triple NIH's annual research spending on that disease, now $34 per patient, to $100 million. Such disease lobbyists regularly trek through Congress, pushing their= causes.=20 In spite of the stigma that still clings to AIDS the relative sums are inspiration enough for egalitarian scepticism in a Congress that considers itself the special guardian and promoter of health research. And so, at the direction of its paymasters in the House, NIH is once again putting together an update of a Cost of Illness Report, due for delivery in the next few weeks, detailing how it spends its budget. The report will provide a background for a special hearing by the House appropriations subcommittee for NIH.=20 On the basis of NIH's earlier encounters with the body-count school of biomedical budgeting, the rationale for the status quo will focus on scientific opportunity, rather than patient load, as the lodestar for biomedical strategy. In many appearances before Congressional committees, NIH director Harold Varmus has defended this approach as the most promising path to the goals of prevention and treatment of disease. And he has a strong ally in the most strategically situated legislator for NIH affairs in the House, Representative John Porter (Republican, Illinois), who became chairman of the NIH appropriations subcommittee in 1995.=20 In harmony with Varmus' preferences, Porter has banished the traditional Congressional practice of "earmarking" NIH funds for research on diseases that have aroused the interest of sympathetic legislators. Under Congressional supervision, Porter has argued, professional scientific and medical judgment should determine biomedical research strategy. Within his own jurisdiction, he has so far been successful. But the pressures for reverting to the old system remain strong, and are not all located in= Congress.=20 Along with his recent predecessors in the White House, President Clinton is strongly opposed to Congressional earmarking of funds because it reduces presidential authority over spending. The president, however, does not go as far as Congressman Porter in delegating biomedical authority to the professionals at NIH. For example, in response to the public sympathy for the actor Christopher Reeve, who was paralysed in a riding accident in 1995, Clinton directed NIH to spend an additional $10 million on spinal-injury research. Given no say in the matter, the NIH management privately disagreed and then glumly did as it was told. The episode, small stuff in the context of NIH's $12=B77 billion budget, gives heart, however, to the body-count budgeters.=20 For decades, Congressional pinpointing of NIH funds for this or that disease was the norm. The instincts for doing business that way have been suppressed for a few years. But they could roar back at any time.=20 Daniel S Greenberg=20 The Lancet,Volume 349, Number 9060 - Saturday 26 April 1997 http://www.thelancet.com/lancet/User/vol349no9060/news/index.html#newsin Margaret Tuchman (55yrs, Dx 1980)- NJ-08540 [log in to unmask]