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Strategies to Leverage Research Funding: Guiding Dod’s Peer Reviewed Medical Research Programs
(NBCC), which was created in May 1991 (Casamayou, 2001). In October 1991, NBCC’s efforts generated 600,000 letters to Congress and the White House that asked for increased spending on breast cancer research, and in February 1992, NBCC held research hearings during which leading breast cancer scientists identified research needs. On the basis of this meeting, NBCC began to campaign for “$300 million more” for cancer research and emphasized the need to fund research in ways that were different from those employed by traditional federal medical research agencies (Visco, 2004).
Lobbying by breast cancer groups had previously resulted in congressionally mandated funding increases for breast cancer research at DOD and the National Cancer Institute (NCI) in the fiscal year (FY) 1992 federal budget. The DOD budget earmarked $25 million for research on the screening and diagnosis of breast cancer among military medical beneficiaries and their dependents. Congress also directed NCI to increase its efforts in breast cancer research, as well as prostate and ovarian cancer research, by $100 million in FY 1992. However, the Budget Enforcement Act of 1990 imposed a strict cap on budget increases in domestic discretionary programs, and an increase of only $30 million was provided to NCI in FY 1992. Even with this increase, cuts in existing cancer research programs were necessary to accommodate the new mandates from Congress. This was the first time that cuts in ongoing cancer research programs were required to provide increases for new cancer research initiatives.
In addition, although this budget increase raised breast cancer research spending at NCI to $133 million in FY 1992, this was still substantially less than the $300 million urged by NBCC. As a result, many members of the cancer research and advocacy communities, spearheaded by NBCC, worked with Congress to identify a source of new funds for breast cancer research that would not further reduce the funding for existing cancer research programs.
One attractive source of funding at that time was DOD, which had approximately $29 billion in unobligated funds from prior years for the development of weapons systems planned before collapse of the Soviet Union in 1991.1 Those funds were put off limits by the Budget Enforcement Act of 1990, which established “firewalls” between the budgets for defense, foreign affairs, and domestic programs and imposed strict caps on funding increases in each of the three categories. A number of attempts were made to breach the firewalls by transferring defense funding to domestic programs, including two attempts in September 1992 that would have increased funding for breast cancer research specifically, but they all failed.2 Ultimately, Senator Tom Harkin put forward an amendment
Congressional Budget Office estimate quoted by Senator Arlen Specter during debate on the Harkin transfer amendment in September 1992 (Congressional Record, September 16, 1992, p. S13594).
Senator Harkin proposed a amendment to the Senate Labor-HHS-Education Appropriations bill for FY 1993 that would have taken $4.1 billion from the defense budget to augment programs in the