of minority groups, elderly people, and children. Some worry that NIH is not paying enough attention to or investing adequately in particular kinds of research—the state of clinical research is currently a big issue—or crosscutting activities (such as prevention or nutrition) or important fields, technologies, and approaches (such as bioengineering, medical imaging, and alternative medicine).

For these reasons, authorization bills and appropriations committee reports have until recently contained some fairly specific directives. These have included mandates to establish particular offices or centers in institutes or in the Office of the Director, the use of certain mechanisms (such as centers, clinical trials, or specific requests for applications), or the use of set-asides of specified amounts of funding for a particular activity.

Many Congressional leaders would prefer to rely on NIH to allocate funds among research programs, but first, they are mindful of their important oversight responsibility. NIH is part of a very important public function and has a very large budget. Second, members of Congress are constantly approached by individuals and groups about the impacts of terrible diseases, and they want to show that they are trying to help. At the same time, many believe that NIH should be making the decisions about the allocation of funding among research areas, because they are aware that the opportunity for advances varies from one problem to another. Thus, the legislators want to be able to refer people to an identifiable process at NIH and be assured that NIH is in fact listening and taking what they hear into account, that is, that the inputs of all interests have been fairly and appropriately taken into account in program and resource allocation decision making.

The existence of such a process is not clear to all members. Members of Congress are constantly exposed to disease-specific interest groups that have statistics on disease burdens and lists of scientific opportunities and argue that they are neglected in terms of the amount of funding for research on their disease of interest as reported by NIH. They wonder: How does NIH know that an area of research is emerging and when and how to respond? How are measures of disease burden and costs taken into account and how does the public have input? Does the NIH priority-setting process need to be changed, or is it working well and the need is just for better communication?

How Congress Communicates Priorities

As noted, NIH operations, structure, and funding are affected most by four congressional committees: the authorization and appropriations committees in each house. The authorization committees are the House Committee on Commerce (Subcommittee on Health and Environment) and the Senate Committee on Labor and Human Resources (Subcommittee on Public Health and Safety).



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