<http://www.nature.com/>http://www.nature.com/
NATURE, March 12, 1998
NIH's way of setting priorities endorsed
Washington. An expert panel charged with deciding whether the US
National Institutes of Health (NIH) should change the way it sets
research
priorities heard general praise for the agency's methods last
week, and
seemed averse to recommending dramatic changes when it reports in
July.
Last week's meeting marked the launch of a study by the Institute
of
Medicine (IOM) into whether the way in which the NIH sets
priorities for
distributing its $13.65 billion - and growing - budget should be
changed,
honed or left alone.
Judging from the tenor of the meeting, the committee is more
likely to
recommend incremental reforms than a dramatic overhaul. "We're
not
dealing with something that's broken," says Leon Rosenberg, a
professor of
molecular biology at Princeton University who chairs the
20-member panel.
"We're looking for ways to make a good thing better."
NIH directors who addressed the panel suggested one way that
might be
achieved: by Congress ceasing to burden the agency with legal
requirements
to spend money on particular diseases. Such constraints "deform"
science,
they said.
The $338,000 IOM study was ordered last year by Congress. It was
prompted by the perennial tug of war between the scientific
community,
which prefers a free hand in deciding how it spends research
dollars, and
advocates for dozens of diseases, who argue that their causes are
underfunded by NIH in a process that excludes the public.
Both sides have support in Congress. Last week Representative
John Porter
(Republican, Illinois) took Donna Shalala, the secretary of the
Department of
Health and Human Services, to task for what he alleged was White
House
meddling in NIH priority-setting. President Bill Clinton "is
setting one disease
against another" by seeking in his 1999 budget a five-year, 65
per cent
increase in cancer research spending at the NIH, said Porter.
Porter, who chairs the House of Representatives appropriations
subcommittee that funds the NIH, said Clinton had opened "a
Pandora's
box" with the proposal. Shalala defended the proposed increase as
"not
inappropriate" because, during the same five- year period,
overall NIH
spending would increase by 48 per cent. She said "cancer is on
the cusp of a
series of major breakthroughs and this additional investment will
make a
major difference in the quality of life".
The issue is also coming to a head this year because of the
concerns of
Senator Bill Frist (Republican, Tennessee), a medical doctor who
chairs the
subcommittee on public health and safety of the Senate Labor and
Human
Resources Committee, and who is responsible for drafting a large
"reauthorization" bill for the NIH.
The bill will set broad directions for NIH's work over several
years. Frist
wants to use the IOM study to explain to Congress how NIH reaches
its
decisions. In general he opposes attempts to direct NIH to spend
specific
sums on research on specific diseases.
Frist's aide Anne Phelps told the IOM panel that "the whole
impetus for the
study" is to have a "process in place" against which to examine
proposals for
specific disease spending by members of Congress "other than
debate on the
Senate floor".
Phelps added that, with broad congressional support for doubling
the NIH
budget over five to ten years, Frist is feeling pressure from
disease advocacy
groups and their congressional supporters. She expressed a worry
that
members of Congress will pick five or six areas of research
emphasis in the
reauthorization bill. "We are very concerned about what will be
missing."
There was praise for Harold Varmus, the NIH director, from Adam
Yarmolinsky, a panel member who is a professor of public policy
at the
University of Maryland. He told Varmus at the meeting that he was
doing a
"superior" job of prioritizing.
Yarmolinsky suggested that NIH does not need the panel's "ideas
about
how to prioritize better," but rather its advice on how to
justify the agency's
decisions to the public.
Varmus asked the panel to consider whether there should be ways
to make
"more radical changes", having effects as big as fusing
institutes or halving
institutes' budgets. Although such drastic measures are
"impossible
politically", he said, the panel could consider other ways of
achieving change
if it did not think the changes NIH makes from year to year are
"big enough".
On the issue of NIH responsiveness to the public, Varmus said he
has
learned "a lot" from highly educated disease advocacy groups. But
he added:
"There is a point beyond which the decision has to be reserved"
for agency
officials.
The institute directors who addressed the panel rallied around
the current
NIH process. Priority setting "is a complicated process, but you
want it to
be," said Francis Collins, director of the National Human Genome
Research
Institute. He likened any dramatically simpler scheme to landing
a 747
aeroplane with a "joystick".
The directors warned against Congress earmarking research funds.
Steven
Hyman, director of the National Institute of Mental Health, said
that a
congressional requirement to devote 15 per cent of research
spending to
health services research, "lost [us] a substantial percentage of
our basic
neuroscience portfolio. People simply went away." Earmarking
"entrenches
self-interested constituencies" and "deforms" science, Hyman
added.
But all the directors conceded an important role for public input
into the NIH
process. John Alderete, a panel member who is a professor of
microbiology
at the University of Texas Health Science Center at San Antonio,
said NIH
needs to be more responsive to the public if it wishes to avoid
earmarking of
funds.
Meredith Wadman
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DOB: 1941/Dx: 1980/Cured:ASAP
Slogans wont do it/Hard work will
