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Society's Choices: Social and Ethical Decision Making in Biomedicine
agenda. One reason for growing public interest in scientific expenditures is the sheer size of the government-funded program of biomedical research. The NIH budget alone grew from $26 million in 1945 to over $10 billion in 1993, and the Clinton administration's budget request for FY 1994 is $10.668 billion. Almost 90 percent of the funding goes to extramural research. Additional matching funds are applied to the construction of biomedical research facilities. For its part, NSF has a FY 1994 budget request of $3.182 billion to fulfill its scientific mission.
The establishment and success of these premier scientific research agencies resulted partly from the early insights of Vannevar Bush, head of the wartime Office of Scientific Research and Development, who pointed out in his book, Science-The Endless Frontier, the importance of the uninterrupted flow of new scientific knowledge for both health and defense. To accomplish these purposes, Bush proposed a permanent governmental structure receiving funds from Congress to support basic research in the colleges, universities, and research institutes, as well as scholarships and fellowships for training. Bush specified that this proposed agency should recognize the importance of freedom of inquiry on the part of the individual scientist.
Today, it is precisely this unfettered freedom of the individual scientist to determine research priorities that is being questioned. Yet, who should be setting the priorities for science? Congress must respond to a variety of pressures from constituents, resulting in academic earmarks to fund "pork barrel," non-peer-reviewed science at levels that have grown from about $10 million in 1980 to almost $800 million in 1993 ( Washington Fax, 1993). Congress also responds to the voices of special interest groups by specifying funding levels for specific diseases. Scientists as a group have not developed a way to effectively establish research priorities across the various fields of scientific endeavor. Unfortunately, Congress also seems to lack a mechanism for obtaining objective data to help to weigh scientific priorities across the spectrum of important diseases.
At the same time that the public demands greater accountability in the funding of biomedical science, it is generally optimistic about the ultimate outcome of its investments. A 1990 survey by the National Science Board showed that most Americans trust the motives of scientists; 80 percent of respondents agreed that most scientists want to make life better for the average person (National Science Board, 1991). The survey also showed that between 1979 and 1990, decreasing proportions of respondents agreed with the statement that "Science makes our way of life change too fast." Most respondents indicated that they believe that the benefits of scientific research had outweighed the harmful results; a majority perceived a strong link between advances in science and technology and improvements in their own daily lives.