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Margaret, Greenberg's article really gets me angry. First it was published by Lancet as a news brief rather than an editorial. I did some research on Greenberg and he is an American Columnist who is used writes a great deal supporting AIDS research. He appears to support the least amount of control possible over the research community. I think he is such an Aids research supporter that he fears money being taken from that. The insensitivity to the needs of others by the sarcastic Disease of the Month Club reference is especially galling. Also where would AIDS research funding be if it wasn't for the activism of the AIDS community. I would go so far as to say that AIDS is a much greater threat to society than PD but to put us down for trying and to put our allies down for responding to us is bullshit(no politer word will do).=20 I plan to write a letter to the editor of Lancet. =20 Charlie Margaret Tuchman wrote: > I wonder if the author, Mr. Greenberg, has ever had a need to "rattle h= is > cup",begging for > care that is rightfully his?? >=20 > The Lancet,Volume 349, Number 9060 - Saturday 26 April 1997 > http://www.thelancet.com/lancet/User/vol349no9060/news/index.html#newsi= n >=20 > WASHINGTON NIH resists research funding linked to patient load >=20 > In the politics of biomedical research here, the challenge of the seaso= n 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 mismat= ch > between the number of patients afflicted by a particular disease and th= e > proportion of the NIH budget devoted to research on that disease. >=20 > When the arithmetic has suited their purposes, the "disease-of-the-mont= h > clubs" that surround NIH have always grumbled about what they regard as > inequities. But a sense of gross injustice has been fostered by the met= eoric > growth of funds for AIDS research--from US$200 million in 1981 to $1=B7= 5 > 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, $20= 9. 2 > weeks ago, advocates of increased spending on Parkinson's disease ralli= ed on > Capitol Hill in support of legislation that would nearly triple NIH's a= nnual > research spending on that disease, now $34 per patient, to $100 million. > Such disease lobbyists regularly trek through Congress, pushing their c= auses. >=20 > In spite of the stigma that still clings to AIDS the relative sums are > inspiration enough for egalitarian scepticism in a Congress that consid= ers > 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 tog= ether > 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 subcommitt= ee > 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 committee= s, > NIH director Harold Varmus has defended this approach as the most promi= sing > path to the goals of prevention and treatment of disease. And he has a > strong ally in the most strategically situated legislator for NIH affai= rs in > the House, Representative John Porter (Republican, Illinois), who becam= e > chairman of the NIH appropriations subcommittee in 1995. >=20 > In harmony with Varmus' preferences, Porter has banished the traditiona= l > Congressional practice of "earmarking" NIH funds for research on diseas= es > that have aroused the interest of sympathetic legislators. Under > Congressional supervision, Porter has argued, professional scientific a= nd > 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 C= ongress. >=20 > Along with his recent predecessors in the White House, President Clinto= n is > strongly opposed to Congressional earmarking of funds because it reduce= s > 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 f= or > the actor Christopher Reeve, who was paralysed in a riding accident in = 1995, > Clinton directed NIH to spend an additional $10 million on spinal-injur= y > research. Given no say in the matter, the NIH management privately disa= greed > and then glumly did as it was told. The episode, small stuff in the con= text > 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 di= sease > was the norm. The instincts for doing business that way have been suppr= essed > for a few years. But they could roar back at any time. >=20 > Daniel S Greenberg > The Lancet,Volume 349, Number 9060 - Saturday 26 April 1997 > http://www.thelancet.com/lancet/User/vol349no9060/news/index.html#newsi= n > Margaret Tuchman (55yrs, Dx 1980)- NJ-08540 > [log in to unmask] --=20 ********************************************************** CHARLES T. MEYER, M.D. MADISON, WISCONSIN [log in to unmask] **********************************************************