Medical Research

Prioritizing Health Research Spending

President Clinton has proposed increasing the $13.6 billion fiscal year 1998 budget of the National Institutes of Health (NIH) by 50 percent over five years, and House Speaker Newt Gingrich (R-Ga.) has called for doubling spending over eight years. But scientists say the 21 institutes and centers that comprise the NIH -- the primary federal agency funding health research -- do not allocate health research dollars as well as they could.

Researcher Tammy O. Tengs of the School of Social Ecology at the University of California at Irvine, says NIH-funded research has not yielded the public health dividends expected. For example, while many people now survive cancer, cancer rates overall actually increased by 6 percent from 1970 to 1994, despite billions of dollars in research.

  • Furthermore, says Tengs, research funding decisions are often politicized -- for instance, $150 million was recently earmarked for diabetes research after the president and speaker personally interceded.

  • Also the NIH does not have consistent information about the relative economic and public health burden of various diseases with which to prioritize spending.

  • And it has no overall goal for setting priorities, no long-range strategy and no systematic way of measuring progress.

The goal of health research, says Tengs, should be reducing the future burden of disease according to a single, comprehensive measure of cost effectiveness that captures the years of life lost -- adjusted for quality of life -- disability and economic losses.

Based on the number of deaths caused by various diseases, NIH funding seems skewed -- spending $111 per death from AIDS, compared to $10 per death from cancer, $3 for heart disease and $2 for stroke. Based on the number of people affected, NIH spends $1,069 for each person afflicted with HIV/AIDS, $296 for cancer, $158 for multiple sclerosis, $93 for heart disease, $54 for Alzheimer's and $26 for Parkinson's.

Source: Tammy O. Tengs, "Planning for Serendipity: A New Strategy to Prosper from Health Research," Health Priorities Project Policy Report No. 2, July 1998, Progressive Policy Institute, 518 C Street, N.E., Washington, D.C. 20002, (202) 547-0001.

Would "Ordinary Citizens" Allocate NIH Funds Better?

A panel appointed by the National Academy of Sciences wants the National Institutes of Health to listen more closely to patients and ordinary citizens when deciding how to spend its $13.6 billion annual budget. It also recommended that the agency consider data on the prevalence, death rates and costs of different diseases in setting its research agenda and priorities.

The 19-member panel presented comparisons of how much NIH is spending for research on particular diseases vis-a-vis the number of deaths occasioned by those diseases in 1996.

  • For every AIDS death, NIH allocated $43,206 in research -- for a total of $1.4 billion (see figure).

  • Research into heart disease commanded only $1,160 per heart-disease related death -- at a total cost of $851.6 million.

  • Yet 733,834 heart patients died in 1996, versus just 32,655 from AIDS.

  • Cancer research garnered $4,723 per cancer death that year -- or $2.570 billion for 544,278 deaths.

The report stated that such data encourage "the perception of some members of Congress and the public that NIH spending often follows current politics and political correctness, or responds to media attention to certain diseases."

The report estimates that direct costs to society from heart disease totaled $70 billion a year, while costs from AIDS were $10.3 billion.

Source: Robert Pear, "Health Agency Urged to Review Spending," New York Times, July 9, 1998.

Despite Evidence, More Breast Implant Studies

At a news conference yesterday, Sen. Barbara Boxer (D-Calif.) called for spending taxpayer dollars to once again look for a connection between silicone breast implants and connective tissue and other diseases. But policy analysts say numerous studies have found no link between silicone breast implants and any of the alleged disorders. For instance,

  • Women with breast implants are not at increased risk for breast cancer, concluded a September 1997 review of studies in the Journal of the National Cancer Institute by Food and Drug Administration and National Cancer Institute researchers.

  • Silicone breast implants do not pose a large risk of connective tissue diseases, concluded a study of 10,000 women by the Harvard Medical School and Brigham and Women's Hospital reported in the Journal of the American Medical Association in February 1996.

  • A study of 87,501 nurses in the June 1995 New England Journal of Medicine found "no association between silicone breast implants and connective tissue diseases, according to a variety of standardized criteria."

  • A 1992 study by the University of Washington Fred Hutchinson Cancer Research Center found no "increased risk for rheumatoid arthritis among women with silicone breast implants."

In addition, two congressionally mandated studies are already under way -- one at the National Cancer Institute and one at the Institute of Medicine at the National Academy of Sciences.

Source: Amy Moritz Ridenour, "Alar Redux: Hollywood Peddles Shaky Science Once Again," National Policy Analysis Paper No. 202, June 10, 1998, National Center for Public Policy Research, 300 Eye Street, N.E., Suite 3, Washington, D.C. 20002, (202) 543-1286.

For text http://www.nationalcenter.org/NPA202.html

How Research Can Save More Lives

Almost all federal spending on medical research is funneled through the National Institutes of Health (NIH), which have an annual budget of about $12 billion. However, according to economist Gary S. Becker, the distribution of research funds among diseases isn't the allocation that would give the greatest overall benefit.

While diseases that cause a greater number of deaths generally get more research dollars, he points out that the amounts spent per death caused by each disease are very different. For example,

  • NIH research funding amounts to more than $4,000 per death from cancer, but only a little above $2,000 per death from heart disease -- which causes about 50 percent more deaths than cancer does.

  • NIH spends five times as much on breast cancer as on prostate cancer, even though they cause about the same number of deaths per year.

  • Per death caused, AIDS research receives four times the funding of breast cancer, more than 20 times prostate cancer, and almost 50 times heart-disease research.

Some illnesses may receive proportionally more funding because they cause more pain and suffering, there are better prospects for important research advances or the victims are younger. However, Becker suggests that to some extent funding decisions are politically influenced by how well organized are the people concerned with a particular disease.

There is a case for spending more money on medical research since potential benefits from basic medical advances are so large. Even current spending levels would be much more effective in promoting medical progress and saving lives if research funds were allocated to provide the greatest overall benefits to society.

Source: Gary S. Becker (Hoover Institution), "The Painful Political Truth About Medical Research," Business Week, July 29, 1996.

Is The War On Cancer Lost?

After 26 years of research and $30 billion in spending, the federal government's "War on Cancer" has failed to reduce death rates, concludes a study by University of Chicago researchers.

  • Since 1970 the cancer death rate has grown by 6 percent -- from 189.6 deaths per 100,000 people to 200.9.

  • Since 1990 government spending on cancer research increased from $1.6 billion a year to $2.25 billion in 1996.

  • Overall cancer mortality among people older than 55 increased by 15 percent to 20 percent, which was somewhat offset by a 25 percent drop in deaths among people younger than 25.

The latest study is an update by researchers John Bailar and Heather Gornick of a 1986 Bailar report covering 1950 to 1982. That report caused a furor by concluding that, "Some 35 years of intense effort focused largely on improving treatment must be judged a qualified failure."

Now, he writes, "with 12 more years of data and experience, we see little reason to change that conclusion." He says that money spent on new treatments "certainly hasn't paid off" and he "can't see whether it will ever pay off."

He would shift funds from cancer research to cancer prevention -- such as campaigns against smoking and for people to adopt healthier lifestyles. Skeptics, however, point to a myriad of such government exhortations which have had questionable results.

Source: Steve Sternberg, "$30 Billion 'War on Cancer' a Bust?" USA Today, May 29, 1997.

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