How NIH allocates funding among areas of research has become a major issue over the past several years. As noted in Chapter 1, Congress has inquired about priorities among specific diseases or programs on a number of occasions since 1995. Some legislators believe that the distribution of NIH funding does not adequately reflect the number of citizens affected by various diseases or the costs of various diseases to society. Advocates for individuals with various diseases tell Congress that NIH is neglecting research on their focal disease relative to the levels of research on other diseases. Congress has also become concerned about how NIH allocates funding to areas that are not disease-specific, for example, clinical research (versus basic research) and public health education.
In response to concerns about how it allocates funding among categories of research, NIH recently published ''Setting Research Priorities at the National Institutes of Health," a 15-page booklet describing the criteria and processes that it currently uses (National Institutes of Health, 1997b) (referred to hereafter as Setting Research Priorities). In its FY 1999 budget request, NIH told Congress that the booklet "delineated" NIH's priority-setting principles and mechanisms and that NIH would "continue to consider the full array of relevant criteria in setting priorities for research funding, including the societal and economic costs associated with particular diseases and disorders" (U.S. Department of Health and Human Services, 1998:OD-33).
Setting Research Priorities lists five major general criteria that NIH calls "both influential and continuous" in priority setting (National Institutes of Health, 1997b:4). These criteria are
According to NIH, these criteria are used to set priorities in a broad and complicated program with multiple goals and numerous levels. They are used in a process that allocates funding among NIH institutes and centers and, within each institute or center, among a hierarchy of programs. These allocation choices affect how much goes to basic versus clinical versus epidemiologic