development (R&D) funding is sparse, this information was supplemented by committee members’ judgment and experience as seekers of funding, recipients of governmental and private-sector research support, proposal reviewers, and managers of research programs.

This report addresses the question of whether it is possible and desirable to augment the appropriated dollars for CDMRP with funding from other sources. The answer to the of whether it is possible rests on an analysis of nonfederal sources of funding and mechanisms that may be available to access them, as well as potential impediments to that process. The answer to whether it is desirable rests on an analysis of how these other sources and funding mechanisms might affect the goals and effectiveness of CDMRP. Desirability also depends on how “augmentation” is defined. Augmentation of funding that increases public health, for example, by creating a critical mass of knowledge or skills, or by joining complementary resources that are needed to solve a problem, or by enabling results that would not otherwise be possible, is more desirable than augmentation that only serves to extend program funds, especially if the additional funds are not newly applied to biomedical research and are simply shifted from other biomedical research uses.

CDMRP occupies a niche in the spectrum of federally-funded medical research: it emphasizes high-risk exploratory research and new ideas by supporting projects that have little or no preliminary data and new investigators without an established track record in research. Based on testimony from program officials, grantees, and members of the advocacy community presented at an April 2004 workshop (see Appendix C for workshop agenda and participants) and an evaluation conducted by an earlier committee of the Institute of Medicine (IOM, 1997), the program appears to be well-run, supports high-quality research, and contributes to research progress in its areas of focus. It also concentrates its resources on research mechanisms that complement rather than duplicate the research approaches of the major funders of medical research in the United States, such as industry and the National Institutes of Health (NIH).

CDMRP’s strategy of focusing on support of exploratory research, new investigators, and innovative approaches affects the prospects for outside funding. Funding of such work is generally and properly regarded as a function of the federal government, making up for market failures that result in private-sector underinvestment in these vital areas. Nonfederal funders—particularly philanthropic organizations and state governments—are unlikely sources. Given the disparity between the amount of federal resources relative to nonfederal resources, they have little motivation to provide funds unless they expect to leverage federal dollars for their priorities or they would like the federal program to pay for the application, peer review, and grants management processes.

Leveraging of nonfederal funds would happen most easily for certain types of research that are not the main focus of CDMRP and that are already supported

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