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Setting Federal Science and Technology Priorities Defense, health, foreign affairs, space, commerce, and transportation all contain elements of science and technology. The science and technol- ogy issues in these various sectors are affected increasingly by governmental processes in the administration and Congress and are evaluated and judged on their importance to the larger governmental mission.) Federal science and technology priority setting is a complex procedure involving the Presi- dent, Congress, the scientific community, the public, and their many special interest groups (Figure 3-1~. Federal priorities are often reflected in the amount of funds allocated to each portion of the budget. In recent years there have been enormous fiscal pressures on all federally financed programs because of growing federal debt. These budget constraints have become particularly acute since the enactment of the Balanced Budget and Emergency Deficit Control Act of 1985, also known as the Gramm-Rudman-Hollings Act (GRH), which has sought to reconcile annual federal revenues and outlays in a concerted effort to balance the federal budget by 1992. Thus, the committee feels that it is important to be fully aware of the organizational structure and processes of the federal health sciences establishment as well as the external forces that are shaping the federal budget. 62

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64 FUNDING HEALTH SCIENCES RESEARCH SCIENCE ANT) TECHNOLOGY AI)VICE TO GOVERNMENT Presidential Science and Technology Advice A formalized system for science advice to the President dates back to the 1940s to President Roosevelt's administration during World War II. After the war President Human, with strong encouragement from con- gressional leaders, sought advice in organizing a body to provide scientific advice to the executive office. Beginning in 1951, the Science Advisory Committee to the President was located in the Office of Defense Mobiliza- tion. The launching of Sputnik focused public attention on the American scientific establishment, and in 1957 President Eisenhower created the Pres- ident's Science Advisory Committee (PSAC) and designated its chairman as his special assistant for science and technology.2 Although P SAC was concerned primarily with the military aspects of scientific research, it laid the groundwork for scientific advisors for later administrations. P SAC was sanctioned officially by executive order in the Kennedy, Johnson, and Nixon administrations. During these administrations, PSAC's role was defined by the incumbent President and generally emphasized military weapons eval- uation, although in the 1960s PSAC's scope expanded to include civilian scientific endeavors as well. During the Nixon administration, P SAC was regarded highly by the scientific/technical community; however, the internal working structure of the Nixon White House and the various departments and agencies did not share this view.3 Much of the work by the Nixon P SAC was self- initiated, and P SAC thus was criticized for meddling in the internal affairs of government departments. PSAC was abolished by President Nixon in 1973, apparently because of growing divergences between PSAC and p res id e nt ia l- leve l viewpo in Is . 4 Congress sought to eliminate the problems experienced with PSAC in providing scientific advice to the President by passing the Science Advisory Act of 1976 (P.L. 94-282~. This legislation made the head of the Office of Science and Technology Policy (OSTP) equivalent to the heads of other executive offices, such as the director of the Office of Management and Budget (OMB) or the Chairman of the Council of Economic Advisors. With this act Congress attempted to improve the science advisor's access to the President and avoid the political pitfalls experienced by P SAC by mandating specific functions for OSTP that would be subject to congres- sional oversight.5 Congress also attempted to provide OSTP with sufficient staff to deal with a broad spectrum of issues, without diluting its e~ective- ness. Lastly, Congress sketched out in the act the elements of a national science and technology policy, identifying 10 areas of national importance that defined the charge to the science advisor. The law broadly states the

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SETTING FEDERAL SCIENCE AND TECHNOLOGY PRIORITIES 65 charge to the science advisor: "The primary function of the Director of OSTP is to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest levels of government." The Science Advisory Act included provisions for an Office of Science and Technology Policy, with a director and as many as four associate directors appointed with the advice and consent of the Senate. Although Congress authorized four associate directors, no more than two of these positions were ever filled at any one time until this year. Also, an adequate staff is necessary to address the broad scope of responsibilities assigned to the science and technology advisor and the associate directors of OSTP. The number of full-time permanent staff in OSTP has declined from 23 in the late 1970s to 11 in early 1989. Moreover, Congress has severely limited the use of "detailees" or borrowed staff from executive agencies and governmental laboratories, who in the past have provided necessary staffing and expertise that is not covered adequately by the budget. Congress expected OSTP to become a major policy arm of government. Despite Congress's good intentions, it has been unable to guarantee that the President or his close advisors will receive information on or give attention to the scientific implications of national policy issues. In the years since the Science Advisory Act was passed, science advice to the President by the director of OSTP has been dealt with in varying ways by the Ford, Carter, and Reagan administrations. The President's science advisor has a dual role as an individual member of the White House staff (often designated Assistant to the President) and the head of a policy office in the Executive Office of the President. However, the relationship between the science advisor and the President depends largely upon the advisory structure and management style within the White House. Some presidents rely on cabinet members as their policy advisors, whereas others use White House advisors to guide their administration. Also, the science advisor's effectiveness is judged by the importance of the scientific issues dealt with by the President as well as the relatedness of science policies to the national agenda. However, a poor relationship with the President may weaken the science and technology advisory capabilities of OSTP. A 1988 report by the National Academy of Sciences entitled Science and Technology He in the White House suggested the optimal func- tions and qualifications of a science and technology advisor and suggested changes in the organization of OSTP.6 The science and technology advisor to the President can fulfill this vital role through activities that shape fed- eral science policy: (1) formulating policy pertaining to the nation's R&D efforts, (2) recruiting senior-level personnel to executive positions in agen- cies with science and technology functions, (3) evaluating R&D budgets, in cooperation with the OMB, (4) coordinating R&D management among the

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66 FUNDING HEALTH SCIENCES RESEARCH various departments and agencies, and (5) advising the President on the implications of international negotiations involving science and technology. In order to provide independent and objective counsel, the Academy report indicated that the science and technology advisor must have certain attributes. These include developing a relationship of trust, mutual respect, and open communication with the President; forming a wide-ranging set of high-quality study groups to focus on important questions; tapping into the scientific community and its institutions in an ongoing, broad-based way, both in government and outside of it; and earning a reputation for integrity without having preconceived answers to technical or policy questions. Ad hoc committees and advisory consultants can play an important role in providing advice to the administration as well. The director of OSTP can readily call upon distinguished members of the scientific and lay community to serve in a short-term advisory capacity by authority of the Intergovernmental Personnel Act. This allows the administration to receive timely information on science and technology issues vital to national interests. Likewise, ad hoc or standing committees can be established to confront those issues needing urgent attention. In the Reagan Administration the White House Science Council (WHSC) was established by George Keyworth under the authority of the Federal Advisory Committees Act in 1981. The WHSC was a bipartisan group of nongovernmental scientists and engineers from academia and in- dustry that reported to the director of OSTP. The WHSC met with the President and other senior members of the Administration to review issues identified by the council or the director of OSTP. After an Year hiatus, the committee advisory function previously performed by PSAC was performed by the WHSC in the Reagan White House, the primary difference being that the chairman of the Council was not the science advisor to the Pres- ident. Insofar as neither PSAC or the WHSC are established by statute, each President and/or his science advisor has the authority to establish an outside advisory mechanism that best suits the administration. In the present administration the director of OSTP, D. Allan Bromley, has created a President's Council of Advisors on Science and Technology (PCAST) that will replace the WHSC from the previous administration.* In much the same fashion as the original PSAC, the director of OSTP will be the chairman of PCAST, and the members will be nongovernmental presidential appointees from a broad spectrum of science and engineering *PCAST members are Norman E. Borlaug, Solomon J. Buchsbaum, Charles ~ Drake, Ralph E. Gomery, Bernadine Healy, Peter W. Likins, Thomas E. Lovejoy, Walter E. Massey, John P. McTague, Daniel Nathans, David Packard, and Harold T. Shapiro.

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SETTING FEDERAL SCIENCE AND TECHNOLOGY PRIORllIES 67 fields. In effect, P CAST will provide vital science and engineering advice to the President through OSTP. The Federal Coordinating Council on Science, Engineering, and Tech- nology (FCCSET) was authorized by the National Science and Technology Policy, Organizations, and Priorities Act of 1986 to evaluate interagency research efforts. FCCSET is composed of the director of OSTP and one representative of each of the following 13 federal agencies: the Depart- ments of Agriculture, Commerce, Defense, Health and Human Services, Housing and Urban Development, Interior, State, Energy, Veterans Affairs, and Transportation, the National Science Foundation (NSI;), Environmen- tal Protection Agency, and the National Aeronautics and Space Admin- istration. Under FCCSET various committees composed of appropriate high-level federal agency representatives can be established to provide a direct link among governmental agencies and can serve as a coordinating mechanism. Under the chairmanship of the science and technology advi- sor, FCCSET can bring together cabinet officials and agency directors to address regulatory, administrative, or budgetary issues of mutual interest. Examples of such efforts include the biotechnology writing group, which answered directly to the White House Economic Policy Council via the science advisor and, more recently, the interagency genome coordinating council.7 The effectiveness of future science and technology advisors to the President will depend largely on the issues that will be confronted, scien- tific interest and priorities of the President and his staff, the professional relationships in the Executive Office of the President, and the expertise and breadth of knowledge of the advisor and his staff. Thus, the committee concluded that appropriate mechanisms are in place for providing effective science advice to the President. Congressional Science and Technology Advice Since the agenda for science and technology ultimately is set by Congress through its authorizing, budgeting, and appropriating activities, advice to Congress and its key science committees is equally important. There are many advisory bodies that provide science and technology advice to Congress. The most public method is by congressional hearing. Ex- perts from universities, industry, and governmental agencies frequently are called upon to testify before congressional committees on issues relating to science and technology policies. Congressional aides also are an important resource for science and technology information. With staff terms lasting longer than many member terms and with a high ratio of advanced degrees among staff members, there is a cadre of scientific support personnel within Congress. Aides

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68 FUNDING HEAI7H SCIENCES RESEARCH assist members in developing information germane to potential legislation, either by researching issues themselves or identifying speakers for hearings. These aides also are helpful in drafting legislation and preparing member presentations on issues relating to pending legislation. Finally, staff as well often gather information from other congressional staff or help the member garner support for legislation. Major research support systems also assist Congress in developing science policy. The Library of Congress maintains a staff in the Science Policy Research Division of the Congressional Research Service (CRS). This group may be called upon to provide information or conduct detailed studies on issues affecting science and technology policy. The CRS maintains a professional staff of 35 to 40 individuals to provide objective nonpartisan reports at the request of congressional members. Experts also are contacted by phone and review report drafts. Another major science policy support resource is the Office of Tech- nology Assessment (OTA). This office was established by Congress in 1972 to conduct in-depth analyses and formulate recommendations for poten- tial legislation, and it frequently tackles major science policy issues. OTA is funded by Congress to conduct these analyses, either in-house or by contract. OTA uses committees to provide expert advice on issues it is evaluating; care is always taken to include representation of the interested public on the committees and to keep the studies free from partisan bias. The General Accounting Office (GAO) monitors expenditures of con- gressional appropriations. As part of its overall mission, the GAO conducts studies on the financial issues related to science and technology. As sci- ence and technology have become increasingly important functions in the government, the need for expertise in science policy in GAO has grown as well. The members' constituencies provide a major source of science policy input to Congress as well. Elected officials are the public's representatives in government. Constituents in the respective congressional districts voice their opinions through letters, meetings, and by forming special interest groups. In some cases these activities influence legislation that directly affects overall science and technology policy. Congressional appropriations for research centers, computers, or facilities in a member's district as a result of earmarking are resource allocations that often avoid customary peer review mechanisms. The National Academy of Sciences was chartered officially by Abraham Lincoln in 1863 to advise the government upon request on scientific and technical matters. Requests quite often are initiated by Congress and carried out under contract from executive agencies. The Academy convenes committees of experts, mostly nongovernmental, to provide information and

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SETTING FEDERAL SCIENCE AND TECHNOLOGY PRIORITIES 69 make recommendations. Thus, the Academy and its associated bodies- the National Academy of Engineering, the Institute of Medicine, and its operating arm, the National Research Council provide science policy advice to the government upon request. In 1988 Congress asked the National Academy of Sciences, the Na- tional Academy of Engineering, and the Institute of Medicine to provide advice on developing an appropriate institutional framework and infor- mation base for conducting cross-program development and review of the nation's R&D programs. The Academy committee identified two overriding questions needing analysis: (1) Is the United States investing adequately for the long term to sustain the enabling science and technology infrastructure? (2) Are priorities among science and technology opportunities decided in a way that best advances the national interest?7 The Academy committee's analysis examined all science and technol- ogy supported directly by the federal government. This included not only the support of basic and applied research but also related activities such as science and engineering education and the financing and operating of specialized facilities. The analysis considered how public officials perceive, prepare, and review science and technology budgets throughout the federal budgetary cycle. Subsequently, the Academy committee suggested an ana- lytical framework and changes in the federal budget process to aid public officials in decisions about science and technology resources. The framework proposed by the Academy committee for guiding sci- ence and technology budget preparation includes consideration of activities and policy objectives across as well as within agencies. The framework includes analysis of science and technology in four interrelated categories: (1) pertinence to agency mission, (2) investment in the science and tech- nology base, (3) pertinence to national objectives, and (4) new and possibly large science and technology initiatives.7 Whereas this framework applies to all science and technology, the committee believes it is applicable equally within the health sciences. Priority Setting Within NIH/ADAMHA The National Institutes of Health (NIH) and the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) are charged with imple- menting a workable plan for improving human health through basic and applied research. A complex system of interactions between the Executive Branch and Congress helps shape priorities within NIH and ADAMHA Administrators in the Public Health Service (PHS) and outside advisory groups are responsible for developing and implementing a strategy to achieve these goals.

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70 Owe of tile Director FUNDING HEALTH SCIENCES RESEARCH The director of NIH, who is a presidential appointee, is primarily re- sponsible for coordinating institute programs and research support divisions along broad policy guidelines. Along with the institute directors, the NIH director must develop NIH's annual budget proposal and defend it before PHS and Congress. In this respect, the director maintains a close liaison with the assistant secretary for health in the Department of Health and Human Services (DHHS), who oversees all activities of the PHS, including budget projections. The NIH director's support staff consists of three deputy directors and several associate directors. One deputy director shares the overall respon- sibilities of the director, acting on his behalf. A second deputy director, the deputy director for intramural research, aided by an associate director for intramural affairs and an assistant director for intramural planning, is responsible for intramural research policy in the institutes and divisions. The third deputy director, the deputy director for extramural research and training, along with an associate director for extramural affairs, oversee grant programs supported by the institutes and administered through the Division of Research Grants. The NIH director is aided by the associate director for AIDS research, the associate director for clinical care, the associate director for science policy and legislation, the associate direc- tor for administration, the associate director for human genome research, the associate director for communications, and the associate director for international research. Under the auspices of an associate director, the Office of Science Policy and Legislation performs the central planning for the director and his staff. This office advises the director on external forces that affect NIH's programs and policies. Responsibilities of this office include policy analysis and development, central program planning and evaluation, and interpreting legislation as it pertains to NIH; the office is responsible as well for publishing NIH Research Plans, NIH Eva1~aiion Plans, Legislative Highlights and Issues, and the NIH Data Book. In addition to the guidance provided by the Office of Science Policy and Legislation, the NIH director receives guidance on NIH programs and policies from several advisory committees, some of which are statutory, such as the President's Cancer Panel, the National Arthritis Advisory Board, and the Board of Regents for the National Library of Medicine. Other advisory committees, such as the Director's Advisory Committee, which convenes to advise the director on broad issues affecting NIH research policies, are unofficial advisory groups appointed by the director. The Director's Advisory Committee generally does not provide guidance on the overall NIH research program. Rather, this body of advisors commonly

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SEITINGFEDERALSCIENCE AND TECHNOLOGY PRIORITIES NATIONAL OFFICE OF BOARD OF ADVISORY THE INSTITUTE SCIENTIFIC COUNCIL DIRECTOR COUNSELORS 1 if_ SCIENTIFIC P ROGRAMS GRANTS Fin LABORA;TO: 71 FIGURE 3-2 A typical NIH institute. (Source: U.S. Department of Health and Human Services, Public Health Service. 1988. NIH Peer Review of Research Grant Applications. Bethesda, Md.: National Institutes of Health.) examines specific cross-cutting issues relating to the research establishment. Several review panels, including the 1976 President's Biomedical Research Panel, that have examined the role of the Director's Advisory Council have recommended that this advisory group be authorized by statute in order to provide a more comprehensive overview of the nation's biomedical research effort. Institute Planning A variety of forces formulate and shape institute research strategies. The structure of a typical institute is shown in Figure 3-2. As does the director of NIH, the individual institute directors have staffs for program planning and evaluation, communications, and special functions. Each insti- tute has an extramural component, and most institutes have an intramural component. Extramural scientific programs include grants, contracts, and cooperative agreements, and they are overseen by a scientific director. The intramural program deals with laboratory and clinical studies conducted within NIH facilities. Institute directors receive advice for institute program planning and di- rection from various groups of advisors: the Boards of Scientific Counselors and the National Advisory Councils. The Board of Scientific Counselors of each institute advises the institute director on intramural research priorities in those institutes having intramural programs; it is also responsible for assessing the intramural programs as well as periodically reviewing tenured scientists within the institute. Often times special presidentially appointed boards may focus program objectives and research directions such as the National Cancer Advisory Board. The National Advisory Council of each institute has the authority to

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72 FUNDING HEALTH SCIENCES RESEARCH define program priorities, primarily by awarding extramural research grants and contracts to investigators in areas it feels are institute priorities. The councils have a broad-based membership of both scientists and lay persons. Generally, they consist of 12 scientists knowledgeable in the field and 6 lay persons as well as ex officio members, such as the institute director and NIH director. The advisory councils do not have scientific support staff nor a budgetary allocation to research issues affecting grants or other extramural awards. Also, there is no official coordination between the Boards of Scientific Counselors overseeing the intramural programs and the National Advisory Councils, which are primarily concerned with the extramural component. Likewise, there is no mechanism for coordinating priorities among the councils of the 13 institutes. FEDERAL BUDGET PROCESS Ideally, once all of the advisory mechanisms have provided the gov- ernment with scientific priorities and goals, a federal budget is developed reflecting this plan. However, because there are so many complexities in formulating the federal budget, the process is never this straightforward. For each fiscal year beginning in October, the President is required by law to submit the budget within 15 days of Congress's convening in the new calendar year, generally by the beginning of February. Since the President's budget is based on agency proposals, the PHS agencies must begin prepar- ing their budget proposals 12 to 15 months in advance of this submission date. Thus, three budgets are being worked on simultaneously: (1) the budget the Executive Branch is developing for 2 years hence, (2) the budget for the next fiscal year on which Congress is having public hearings, and (3) the budget for the current fiscal year that Congress may be revising throughout the year. The following section reviews the federal budget pro- cess as well as the specifics for developing the health research budgets for NIH and ADAMHA Presidential Budget Development Agency Budget Requests Development of the President's budget for health sciences research begins with meetings among agency directors in the DHHS, the Office of the Assistant Secretary for Health (OASH), and the assistant secretary for budget and management. The PHS agencies, including all centers, insti- tutes, and divisions of NIH and ADAMHA, determine their own priorities and desired program levels with the help of outside advisory committees. Several months are devoted to developing program initiatives and evaluat- ing trade-offs for particular funding levels. Subsequently, a formal budget

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SETTING FEDERAL SCIENCE AND TECHNOLOGY PRIORITIES 73 request is submitted to OASH based on estimates for the cost of maintain- ing current services and supporting additional program objectives. These budgets then are passed on to the DHHS, which evaluates them relative to the health objectives of the department and the nation. Concurrently, the President requires that the OMB, the Council of Economic Advisors, and the Treasury Department make separate projections on federal revenues and obligations. Office of Management and Budget The DHHS usually sends its proposed budget to OMB 12 months before the start of the fiscal year (Figure 3-3~. OMB examiners review the budget requests of the individual agencies and evaluate program levels, initiatives, and funding requirements. The budget decisions by OMB are influenced by overall administration fiscal policy in the context of the scientific goals proposed by the department. Once OMB completes its review, the budgets are returned to the agencies with OMB's "mark" of the budget targets that the agencies must meet, usually by sometime in December. If a particular agency disagrees with the OMB mark, it can appeal through department channels to the OMB or directly to the President. Once differences are reconciled, a budget is approved formally by the President and submitted to Congress after the first of the year. In recent years downward negotiations of active research project grant budgets have been specified in the President's budget. For example, the NIH budget request for fiscal year 1989 assumed a 13 percent reduction in the budgets of new research project grant awards and a 10 percent reduction for noncompeting research project grant renewals. Congressional Budget Process Three separate but related processes take place in Congress during the development of the federal budget for health sciences research at NIH and ADAMHA Budgeting, authorization, and appropriation processes are the primary means by which Congress sets its biomedical research priorities. Each of these three processes is dealt with by separate committees in the House and the Senate, with minor variances in committee composition and responsibilities. Authonzing Committees Congress must authorize all federal programs prior to the commence- ment of federal spending; it usually does this for multiyear periods. The Subcommittee on Health and the Environment of the House Committee on Energy and Commerce and the Senate Committee on Labor and Human

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74 FUNDING HEALTIJ.SCT~N~F~ ~,SE~CH 1 989 OCT NOV DEC 1 990 JAN FED MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 1991 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC = Agency Budget Formulation Begins Institutes Formulate Budget Requests Institutes Submit Budgets to NIH ADAMHA NIH 8 ADAMHA Submit Budgets to PHS PHS Submits Budget to DHHS DHHS Submits Budget to OMB OMB Returns Budget with Mark President Submits Budget to Congress Budget Committees Deliberate House Appropriations Hearings Senate Appropriations Hearings House Passes DHHS Appropriation Senate Passes DHHS Appropriation Federal Budget Enacted FIGURE 3-3 Time line of federal budget preparation. Resources initiate authorization bills for research programs in the PHS. This legislation authorizes research activities in the divisions of NIH and ADAMHA as well as specific institutes. Authorization bills also can es- tablish funding levels and time limits on specific programs. This authority to specify program funding levels is the first of many steps Congress takes in shaping the budgets for NIH and ADAMHA However, the NIH has a continuing authority under section 301 of the Public Health Act. This additional authorizing legislation tends to focus upon specific programs and institutes within the NIH. Budget Committees The budget committees of the House and Senate perform an impor- tant but nonbinding function in establishing federal budget spending levels. Based on the best estimates from congressional committees overseeing other federal agencies and projections from the Congressional Budget Office (CBO), the budget committees jointly issue a First Concurrent Res- olution. This document details government receipts, obligations, public debt, and targets for budget expenditures. ~ create the final Concurrent

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SETTING FEDERAL SCIENCE AND TECHNOLOGY PRIORITIES 75 Resolution, a House/Senate conference may be required to reconcile dif- ferences between the chambers. The Concurrent Resolution provides key federal guidelines for the appropriations and finance committees. Since the entire congressional budget committee process takes less than 2 months, a detailed analysis of individual federal programs cannot be conducted. Although the recommendations of the budget committees are non- binding, the passage of the Deficit Reduction Act has constrained the process somewhat. That is, appropriations committees are prohibited from increasing spending levels for specific line items in the budget beyond small percentages specified by the budget committees. For example, increases in discretionary domestic spending could not exceed $3 billion of the total fiscal year 1989 budget of $38 billion for these programs. For fiscal year 1989, NIH's budget was increased by $500 million-18 percent of the entire allowable increases for all domestic programs. Appropriations Committees The recommendations of the budget committees are forwarded to the appropriations committees. In the House and Senate, the 13 subcommit- tees comprising the appropriations committees each receive allocations for the programs in their purview through the process known as 302b alloca- tions. The House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies is responsible for determining the ap- propriations for NIH and ADAMHA In the Senate this same function is performed by the Subcommittee on Labor, Health and Human Services, and Education. One primary difference in the proceedings between the House and Senate is the deferral of training funds by the House. Raining is an unauthorized activity, and to decrease procedural time the House defers action. Thus, the Senate determines the federal commitment to training. The appropriations for the centers, institutes, and divisions of NIH are separate budget line items. The director of NIH and the institute directors are called upon to describe program priorities and provide budget justifications in public hearings during the appropriations process. There- fore, scientific priorities are reflected by fiscal policy in the congressional subcommittees. The Office of Science Policy and Planning in the Office of the Director of NIH is responsible for responding to congressional activities that per- tain to the institutes. On occasion, Congress instructs NIH to undertake specific activities in statutory language of appropriations bills, and NIH must respond with a Legislative Implementation Plan. More commonly, Congress provides NIH with directives through the report language that accompanies the bill. It is possible that three reports can accompany a bill: (1) a Conference Report, (2) a House Report, and (3) a Senate Report.

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76 FUNDING HEALTH SCIENCES RESEARCH Of these, the Conference Report is the most binding. However, NIH tries to comply with these directives and negotiates discrepancies between the Senate and House versions when necessary. AdJu sting Allocations There are mechanisms to adjust the NIH and ADAMHA budgets, up car down, following the enactment of an appropriations bill. The GRH deficit reduction bill automatically cuts federal spending when budget deficits exceed specified annual levels. The NIH and ADAMHA bud- gets can be revised through supplemental appropriations, transfers, or reprogramming. For example, supplemental appropriations were made to NIH and ADAMHA in 1982, 1983, and 1984 to increase funding for AIDS research. This flexibility in the appropriations process is intended to allow Congress to respond to health emergencies. The DHHS cannot transfer appropriations among agencies or repro- gram funds without congressional approval. Transfers are rare, since in lieu of transfer Congress generally will pass a supplemental appropriations bill. On the other hand, reprogramming is fairly common within agencies, and Congress has mechanisms in place to expedite these requests for redis- tributing funds between grants, contracts, and intramural programs within the institutes. Problems Identified by Congress Through committee reports, Congress identifies its intentions as well as specifies issues needing further attention. For example, the President's budget request for fiscal year 1989 stipulated downward negotiations of 13 and 10 percent for new and continuing grant awards, respectively. How- ever, Congress's report language requested that the NIH director reexamine spending plans to limit downward negotiations while maintaining the num- ber of grants supported above the 1988 levels. The House committee also would not approve a 16.2 percent budget increase to maintain cur- rent services for 1989 without an explanation of increasing research costs. Therefore, the committee requested that the inspector general for DHHS review a sampling of extramural awards to determine whether these costs are being well managed.8 Congress has been criticized in the past for micromanaging the NIH budget and earmarking funds for special interests, but it is now attempting to limit that activity. The following statement appears in the fiscal year 1989 House Report: Beyond expressing its concern about funding for investigator-initiated research grants and policies on downward negotiations, the committee has attempted to minimize its directions to the Institutes regarding the specific allocations related

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SETTING FEDERAL SCIENCE AND TECHNOLOGY PRIORITIES to individual diseases or research mechanisms. It is the committee's view that these decisions are best made by the scientists and the science managers at NIH based on the quality of the opportunities as they present themselves during the year.9 SUMMARY AND CONCLUSIONS 77 The committee concluded that the process for setting research priori- ties and developing the federal health budget is very fragmented and deeply embedded in a wide range of political considerations. However, the com- mittee recognized the need for planning among federal agencies to ensure that critical national viewpoints are represented equally well when research priorities concerning use of health sciences research funds are established. Thus, there is a need for a more uniformly accepted priority-setting process that ensures that both scientific and public interests are foremost in the decisions made within the legislative and executive branches of the federal government. The large federal deficits of the 1980s have put tremendous pressures on all federal budget categories. Passage of the GRH Deficit Reduction Act has intensified budget pressures, forcing all federal agencies to strive to meet current services within federal fiscal guidelines. Agencies with science and technology budgets are subject to these constraints as well but generally have been spared some of the budget cuts other domestic programs have endured. The federal government will invest more than $71 billion in R&D in fiscal year 1991. Of this, nearly $10 billion will be invested in health sciences R&D. Industry, foundations, and other sources will contribute an equally large amount. In light of these investments as well as recent economic, demographic, and political developments that affect funding and administration of research programs, it will be necessary to develop a process to establish priorities. Effective advisory mechanisms throughout government are necessary. Additionally, the government must draw upon the collective talent of those scientists performing the work within academic institutions. The committee believes that without better mechanisms for long-range planning, current allocation practices could impede future advances in health sciences research. Continued vitality and progress in health sciences research depend on developing scientific talent and providing adequate laboratories and equipment. The committee believes that more commu- nication among the supporters of health sciences research is needed to maximize the return on the health sciences research investments as well as to restore the balance of support for research projects, training of re- search personnel, purchasing of instruments, and building or renovation of

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78 FUNDING HEALTH SCIENCES RESEARCH facilities. The committee concluded that any changes in resource allocation polic y should foster synergism in the support of health sciences research and ensure that an optimal research environment Is sustained to broaden our knowledge base further. Without careful planning and ongoing oversight, the allocation of resources to meet these needs will be self~efeat~ng. REFERENCES 1. Ford, G.R. 1988. Science advice to the President. In Science and Technology Advice to the President, Congress, and Judiciary. W.T. Golden, ed. New York: Pergamon Press. 2. Roe, R.A. 1988. Science and technology advice for the President and Congress: The need for a new perspective. In Science and Technology Advice to the President, Congress, and Judiciary. W.T. Golden, ed. New York: Pergamon Press. Buchsbaum, S.J. 1988. On advising the federal government. In Science and Technology Advice to the President, Congress, and Judiciary. W.T. Golden, ed. New York: Pergamon Press. 4. Beckler, D.Z. 1988. Science and technology in presidential policymaking: A new dimension and structure. In Science and Technology Advice to the President, Congress, and Judiciary. W.T. Golden, ed. New York: Pergamon Press. Atkinson, R.C. 1988. Science advice at the cabinet level. In Science and Technology Advice to the President, Congress, and Judiciary. W.T. Golden, ed. New York: Pergamon Press. National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine. 1989. Science and Technology Advice in the White House. Washington, D.C.: National Academy Press. National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine. 1989. Federal Science and Technology Budget Priorities: New Perspectives and Procedures. Washington D.C.: National Academy Press. 8. U.S. Department of Health and Human Services; Office of the Inspector General. 1989. Survey on the Cost of Research at Colleges and Universities. Publication No. A-12~9 00128. Washington, D.C. 9. U.S. House of Representatives. 1989. Report of the House of Representatives Appro- priations Subcommittee for the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 1989. Report No. 100-689. Washington, D.C.