AACR believes that while cancer research funding has recently improved, it may decrease in the near future due to budget- balancing pressures and to the rise of managed care, which frowns on picking up patient costs in clinical trials.

In developing the case for more National Cancer Institute (NCI) funding from Congress, Coffey presented some disturbing statistics. He said that if we think of people attending a big sporting event, like a Super Bowl game, one half of the men and one third of the women will develop cancer some day, and 25% of these will die in a very unpleasant way. Deaths from cancer per year are greater than those from all the wars we have fought this century. While violent crime and AIDS currently attract the media's attention, there are in fact 69 murders and 110 deaths from AIDS in a single day, but 1,550 deaths per day from cancer.

When the War on Cancer began, the funding rate for investigator- initiated grants was about 43%. Recently this rate dropped to about 13% and has since risen to 23% because the current director of NCI, Dr. Richard Klausner, has managed to reallocate funds for this purpose. Coffey says, "Let's bring the funding back at least to where it was when the war began!" Cancer treatment costs this country over $100 billion a year and only 2% of that figure is being put into research to cure cancer. Coffey says that this is an abysmally low research and development figure compared to the 21% that drug companies spend. Even the Department of Defense commits 15% of its budget to R&D for achieving its mission, he says.

Considering the odds of getting cancer, the most telling statistic for me is that for every ten dollars we pay in taxes, only one penny goes to cancer research. On the other hand, five times as much goes to NASA to support a space program even its participants find difficult to rationalize. Their main rationale seems akin to that of Sir Edmund Hillary when asked why he wanted to climb Mt. Everest: "Because it's there." Being a senior citizen, I have better than a 25% chance of developing cancer, but what are my chances of dying in an alien attack?

To counter the prospect of reduced funding from congressional appropriations, AACR proposed as the centerpiece of its legislative effort a different source of funding. It is based on the user-fee approach much beloved by budget balancers. Dubbed the National Fund for Health Research (S441) and cosponsored by Senators Tom Harkin (D) and Arlan Specter (R), it would substantially increase the research budgets of the National Institutes of Health (NIH) and, through it, NCI. Under S441, 1% of all health insurance premiums would be allocated to NIH and be distributed to the various Institutes according to the percentages of their present budgets. Since NCI now receives 19% of the NIH budget, or about $2.4 billion per year, it would receive 19% of the $6 billion to be generated from the health insurance levy each year, or an additional $1.14 billion. Money to the fund would be phased in over four years and would go a long way toward achieving AACR's goal of doubling the NCI budget by the year 2000. To prevent Congress from substituting the insurance levy for its normal appropriation to NIH, money from the fund would not be available unless Congress at least maintained current funding.

Unfortunately, AACR is backing a legislative horse that has in the past been entered in Senate races without getting close to the bill-signing finish line. Senator Harkin's plan has received lip service from the scientific community but no real commitment to get it enacted, in past years and this year. When FASEB, a federation of 14 biology and biomedical societies representing 43,000 scientists, put out its report on the prospects for science funding in fiscal year 1998, it mentioned Senator Specter's goal of obtaining a 7.5% increase for NIH but made no mention of S441, which he cosponsors. Similarly, when its president, allied with 200 other organizations including the Ad Hoc Group for Medical Research Funding, testified before a House committee, he pleaded for a 9% increase in the NIH budget, but again there was no mention of S441. The Endocrine Society, allied with the same Ad Hoc group, requested the same 9% percent increase for NIH without any mention of S441. The American Chemical Society (ACS), in conjunction with 46 scientific, engineering, and mathematics societies, supports a joint statement calling for a 7% increase in science funding - without mentioning S441.

A new element in the ACS effort is that a number of city and town mayors have signed onto the joint statement at the behest of the Mayor of San Jose, Susan Hammer. To date 36 mayors have joined in, including those of Los Angeles, Cleveland, Baltimore, and Dallas. It will be interesting to see if this approach adds political clout.

Surprisingly, AACR itself failed to mention S441 in its testimony before the House committee. Rather, it called for a doubling of the budget for NCI by fiscal year 2000, without proposing a funding mechanism. This suggests that AACR is having second thoughts in having S441 as a prominent factor in its effort to get more funding for NCI. AACR probably has gotten the message that there is little support in the scientific community for the Harkin approach of taxing insurance premiums to get more money for NIH.

In discussing S441 with public affairs officers of scientific organizations, I find that they are skeptical of the approach and think that it might actually leave NIH worse off in the end. They think that if S441 were enacted, Congress might abandon health research as a priority and gradually leave its funding to the S441 mechanism. There is a dubious safeguard in the bill against this happening. Even this could be removed in the future. Indeed, I did not see in the AACR analysis of S441 an inflation factor for the congressional obligation. Rather, AACR states that the fund would be activated "as long as NIH received the same appropriation as the previous year." It appears then that, even as written, S441 could become the dominant mechanism for funding NIH as years go by.

Past experience is another factor operating against interest in S441. Societies come to Congress every year with doom-and-gloom scenarios as they request more money for biomedical research, and Congress usually responds. This year, as has often been the case in the past, the chairs of key appropriation committees in the Senate and House are strong supporters of NIH. Senator Specter is calling for a 7.5% increase for NIH, and Representative John Porter (R) is in general agreement with that figure. Science supporters think that the prudent thing to do is to stick with an approach that has worked in the past.

President Clinton is requesting only a 2.6% increase for NIH. With the budget battles looming ahead and discretionary spending under pressure, this year should give us a good indication of how strong NIH's support in Congress really is. If Congress disappoints, the scientific community will be forced to look for other sources of funding, and S441 is a viable option. Another potential source of revenue, rarely considered, is the substantial royalties universities receive when they license patent-worthy ideas to industry. Since government supported the research, it should seek to recover a fair share of the royalties for its supporting agencies without impeding the transfer of technology to the marketplace.

Harry Brodie has been a principal investigator on NIH grants and contracts, and he supervised study sections at NIH in the Division of Research Grants for over fourteen years. He currently is a writer and also works on peer review projects in the Washington, D.C., area.

Send us your comments and ideas for future articles.

Endlinks

Neuroscience Legislative Update - includes the Society for Neuroscience's arguments for the National Fund for Health Research Act.

FY 1998 Budget Request for the National Institutes of Health - American Chemical Society statement supporting greater NIH funding.

The Ad Hoc Group For Medical Research Funding Home Page - "The Ad Hoc Group for Medical Research Funding has one goal: to increase the federal investment in biomedical and behavioral research by increasing the appropriations for the National Institutes of Health." This site has testimony, legislation, and original background material on the NIH.

The Blue Sheet - "up-to-the-minute news and analysis on the role of biomedical research as it's redefined in the changing U.S. health-care system. . . . Each week, The Blue Sheet keeps you informed of National Institutes of Health policies and budget priorities; congressional hearings and legislation affecting research practices, funding and bioethics; Public Health Service initiatives; and activities of the biomedical industry."