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Will the NIH boost allocation to diabetes?
Diabetes is a strong contender in a horse race for research funding, competing with such sure bets as AIDS, cancer, heart disease, and asthma. And while Congress is likely to recommend that the National Institutes of Health (NIH) allocate a sizable chunk of its funding to diabetes research in this year’s budget, the competition for those dollars is strong.
"We’ve got to sell this to Congress," says Steve Smith, national vice chairman of the American Diabetes Association (ADA) in Arlington, VA, and former chairman of the ADA’s government relations committee. "There is a lot of competition from groups advocating funding for research on other diseases."
In February, the congressionally-mandated Diabetes Research Working Group (DRWG) called for $827 million in government funding for diabetes research for the year 2000 and presented a five-year program for research targeting the disease and finding a cure. That funding is part of a huge proposed appropriation for the National Institutes of Health (NIH) in Rockville, MD, which has a free rein to decide how the chunk of money will be allocated. (See box, below right.) This year, the NIH devoted $385 million to diabetes research, out of its $16 billion budget. That’s a bit less than 2.5%.
Congress must act on a national budget by Sept. 30, and the DRWG’s report is likely to be included in that budget. But, Smith says, the NIH has wide latitude in its internal allocation of funding within the organization, and without explicit instruction from Congress, diabetes funding is not likely to be a high priority for those who distribute the funds at the NIH. Unless Congress directs the NIH to implement the DRWG’s plan, Smith foresees a "disaster for diabetes."
Diabetes advocates are coming very close to drawing battle lines with NIH director Harold Varmus, MD, over the issue.
After a special Senate hearing in May, Varmus was depicted on television challenging the DRWG research plan and the need to provide full funding for it and telling Smith he believes the current funding level for diabetes research is "adequate."
Later in the summer, Rep. George Nethercutt (R-WA), co-chairman of the congressional diabetes caucus and DRWG chairman C. Ronald Kahn, MD, director of the Joslin Diabetes Center in Boston, paid a call on Varmus and emerged with a slightly more conciliatory viewpoint.
"I think it helped Dr. Varmus get a perspective on the enormity of the problem of diabetes and its complications, and I think now there is a better appreciation on the part of NIH for the findings and research of the DRWG," says Nethercutt.
Varmus declined to be interviewed or provide a statement for this article. However, in an editorial published in the June 17 issue of the New England Journal of Medicine, he seems to take a poke at diabetes advocates without specifically mentioning the disease. "Advocacy groups have tended, understandably, to focus their attention on alleged inequities between the toll of a specific disease and spending for research on that disease. These claims are of great concern to the NIH, because they threaten to undermine the agency’s credibility.
"This aspect of NIH spending has, in addition, been highlighted by the recent Institute of Medicine report which suggested that the NIH needs to evaluate the burden of disease more carefully and explain more fully to the public how that burden squares with funding patterns," he wrote. "Although current measures are admittedly imperfect and their results often divergent . . . there is a reasonable correspondence between the burden of disease and spending patterns."
Varmus also wrote that NIH policy-makers "consider the prospects for reducing the burden of disease through research, [hence the] relatively high level of spending on HIV and AIDS."
Smith says he doesn’t see the divergent viewpoints of diabetes advocates and the NIH as a controversy. "We have now, as a result of communications with the NIH, focused the attention of Congress to send the signal to the NIH to implement DRWG." And when the budget is passed, the strength of Congressional "recommendation" for the DRWG plan’s funding will be placed in the hands of the NIH, Smith adds.
While 39 senators and 272 representatives have signed an open letter advocating full funding for the DRWG research plan, Nethercutt is a realist and says he thinks Varmus is equally realistic. "The NIH doesn’t want a directive from Congress, but Congress has a role here and wants to present its feelings to the NIH."
Nethercutt says he thinks Congress will stop far short of a mandate that the NIH implement the DRWG’s recommendations, but he expects an attachment to the NIH’s 2000 funding that "strongly urges it in the strongest possible terms. The NIH is not politically insensitive to the fact that this disease touches everybody."
[For more information, contact Steve Smith through the American Diabetes Association, (703) 549-1500 and George Nethercutt at (202) 225-2006.]