Scientific Opportunities and Public Needs Improving Priority Setting and Public Input at the National Institutes of Health (1998) / Chapter Skim
Currently Skimming:
Congressional Role
Congressional Role
Pages 69-80
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From page 69... ...
The health committees have been less prescriptive in recent years, but those who want Congress to specify funding of research on particular diseases can go, and recently have gone, to other places in the system. In recent years, for example, there have been earmarks for breast cancer research and prostate cancer research in defense legislation and an appropriation for diabetes research in the Balanced Budget Act.
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From page 70... ...
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.
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From page 71... ...
They usually appropriate millions more than the president's budget requests, which makes it much easier to influence, if not specify, the use of the appropriation than is the case with appropriations for other agencies in which Congress appropriates about the same amount or a little more or less than the amount requested by the administration. Appropriations committees have a number of ways of communicating intent about executive agency priority setting, including bill language, report language, statements made on the House or Senate floor or at hearings, and informal contacts between committee members and staff and agency officials.
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From page 72... ...
That is not always the case, however. In the late 1980s and early 1990s, NIH budget growth slowed and the number of earmarks specifying amounts of spending on particular disease programs grew.
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From page 73... ...
In that case, the conference committee agreed on a final overall amount for NIAID that was $34 million less than the House recommendation but specifically directed that the increase for pediatric AIDS clinical trials stay at $24 million, which resulted in cuts in vaccine development and other areas of AIDS research. Trends in Appropriations Reports The numbers of items in the reports accompanying the appropriations bills increased between the reports for the 2 years that the committee examined in detail (1993 and 1998)
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From page 74... ...
Lifted the moratorium on human fetal tissue transplantation research. Mandated inclusion of women and minorities in clinical research protocols.
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From page 75... ...
The committee believes that this strategy has been highly productive in the NIH assault on the diseases that afflict Americans. Despite the subcommittee's intentions, the report and accompanying bill in fact contained a number of new set-asides and other provisions that affected NIH priority setting by mandating programs for and directing resources toward specific diseases.
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From page 76... ...
Current proposals include a Center for Alternative Medicine, codification of the General Clinical Research Centers in the PHS Act, a new Institute on Biomedical Imaging, a Center on Bioengineering in NHLBI, a pediatrics initiative, a proposal to use $2.5 billion from a tobacco settlement and earmark one-third for behavioral research, and · initiatives left over from the 1996 reauthorization, including the National Center for Pain Research and a diabetes program.
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From page 77... ...
Perhaps more importantly, the 1984 IOM committee also recommended that NIH rely on a range of activities short of establishing new institutes to respond to heals needs and opportunities. That committee suggested that NIH have "a continuum of possible responses to needs and opportunities it identifies, matched with the magnitude arid urgency of He demand" (Institute of Medicine, 1984: 19~: · publicizing what scientific research has accomplished, and the status and promise of current research in the area; · disseminating the results of research widely to centers that can make immediate clinical use of them; · accelerating research by such means as soliciting applications for grants, scheduling special peer review sessions, appointing special study sections, and utilizing "high relevance scores" for applications in the area con cerned; · holding major conferences with the leaders among the scientists and practitioners concerned to exchange ideas and discuss future actions and, in
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From page 78... ...
There are still calls for new institutes and centers. Today, however, the main focus of interested groups is on having Congress mandate NIH-wide programs or funding levels, or both, for specific diseases or other activities.
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From page 79... ...
Through the appropriations process, Congress directed NIH to reduce the budget for research management and support by 7.5 percent in FY 1996 and did not allow increases in FY 1997 or FY 1998 (although activities designated as related to public health education were exempted from the cap in FY 1998~. Those cuts came after reductions had already been made in response to the administration's Reinventing Government initiative.
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From page 80... ...
Research management and support also includes the capacities that need to be expanded to improve research priority-setting activities at NIH, such as new or expanded Offices of Public Liaison, the new Director's Council of Public Representatives in the Office of the Director, increased consumer participation in all NIH advisory bodies, and improved collection and analysis of disease-related data. Resources invested in these underfunded functions not only should help NIH to fulfill its mission of improving the nation's health but should also improve the effectiveness of public oversight of its activities, thus enabling Congress and interest groups to observe and participate in a process that is more transparent and more satisfactory.
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