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OCR for page 347

OCR for page 347
APPENDIX H ESTIMATING CLINICAL RESEARCH EXPENDI - UPES An estimate of the amount of support for clinical R and D In U.S. medical schools is needed in order to refine our mode' of demand for clinical faculty. The source of most of the medical school data we have been using is the annual edition of JAMA devoted to medical education, but this source does not contain the required estimate. The best data we can obtain from JAMA is total R and D expenditures in medical schools. This is the variable used in demand models in the 1977 report. The approach taken to derive an estimate of clinical R and D expenditures in medical schools is to apply a correction factor to total R and D e~endi- tures. A correction factor which seems appropriate is the property on of total NIH obligations that goes to support clinical research. From 1969 to 1975, this proportion has increased by 56 percent as shown below. This growth rate is much greater than that shown by total NIH research obligations. Clinical Research as Percent of NIH Obligations (NIH, 1975) 1965 1970 1971 1972 1973 1974 1975 ~ . 2596 38% 30% 32gs 34% 3496 39% In the absence of any direct measurements, the above percentages offer the best available means of estimating clinical R and D expenditures in medical schools. Accordingly, they have been used to produce the data shown in Figure 4 . 2 and Tabl e 4 . 1 (Volume 1 ~ . There is of course a serious problem of defining clinical research which clouds any attempt to measure its support. The NIH estimates were derived gen- erally from its Central Scientific Classification System (CSCS) in which each research grant Is classified according to its primary field or discipline. If that discipline falls within a group identified as clinical science, then the grant is tabulated as such. All program project and center grants are identi- fied as clinical by the NIH The classification of any grant is admittedly subjective. Therefore esti- mates derived by this process are subject to considerable uncertainty. Other classification schemes in use at NIH would be likely to produce different esti- ~nates of clinical research from those derived from the CSCS system. But the latter have one advantage--they There produced for a series of years under a constant definition. Thus while the absolute levels may not be very precise, the change from year to year seems to have somewhat more validity. 348