Medical Research To Get More Money From Government

January 05, 1998

Date posted on the Web: January 05, 1998

Robert Pear
New York Times, Late Edition - Final ED, COL 06, P 1
Saturday January 3 1998

WASHINGTON, Jan. 2

In his new budget, President Clinton plans to seek a substantial increase in Federal spending on biomedical research, and members of Congress from both parties say they are virtually certain to approve an even bigger increase.

Science and politics point to the same conclusion. When Congress reconvenes this month, lawmakers will be seeking more money for the National Institutes of Health because they believe that researchers can exploit promising scientific opportunities like new advances in cancer treatment. They also believe that such investments will be popular with voters in an election year.

"We are in a golden age of discovery, one unique in human history," said Dr. Richard D. Klausner, director of the National Cancer Institute, expressing the view of many scientists and lawmakers. Even before Mr. Clinton formally sends his budget request to Capitol Hill early next month, N.I.H. officials have told Congress that the Federal Government must increase its support of biomedical research because managed-care companies, with their emphasis on the bottom line, have reduced the amount of money available to conduct clinical trials of promising treatments. In the past, academic health centers used surplus revenue from patient care to supplement the money they received from the Government, but such surpluses are drying up.

The budget of the health institutes has doubled in the last decade, to $13.6 billion this year. Nonetheless, lawmakers of both parties say they intend to accelerate the increases, and they talk seriously about trying to double the budget of the N.I.H. in five years. That would require annual increases averaging 15 percent, far more than the latest increase of 7.1 percent, from 1997 to 1998.

Anne Thomas, a spokeswoman for the National Institutes of Health, said N.I.H. officials had begun internal discussions so they could answer questions from Congress about how they would use a big infusion of Federal money. In setting priorities, Ms. Thomas said, the agency's director, Dr. Harold E. Varmus, is asking, "Where are the scientific opportunities, and what are the public health needs?"

The Senate voted 98 to 0 last year to endorse the goal of doubling the agency's budget in five years, but did not say where the money should come from.

Two influential Republicans, Representative John Edward Porter of Illinois and Senator Arlen Specter of Pennsylvania, said they were determined to find the money. They are chairmen of the Appropriations subcommittees responsible for health care spending.

In an interview, Mr. Porter said that he had discussed the question at length with Speaker Newt Gingrich, and that Mr. Gingrich "supports doubling the N.I.H. budget in five years, within the overall context of a balanced budget." At a forum on health issues in Smyrna, Ga., in November, Mr. Gingrich said he wanted to double spending on biological research.

Mr. Porter said the Clinton had sought rather modest increases for the health institutes in recent years, knowing that Congress would provide more money than he requested. "That is not honest budgeting," Mr. Porter said.

Republican senators, including Connie Mack of Florida and Alfonse M. D'Amato of New York, said they would join Democrats like Tom Harkin of Iowa and Edward M. Kennedy of Massachusetts in seeking big budget increases for the health institutes. Some Republicans were skeptical about such spending after they took control of Congress in 1995, but they have since been persuaded that biomedical research is an engine of economic growth, with many commercial uses for biotechnology, agriculture and the drug industry.

Senator Kennedy has proposed using money from new tobacco taxes to finance medical research, an idea that seems to be gaining favor on Capitol Hill.

In a recent interview with The New York Times, Mr. Clinton sounded a theme that White House officials said would show up in his State of the Union Message late this month. "I do believe that in scientific terms, the last 50 years will be seen as an age of physics and an age of space exploration," Mr. Clinton said. "I think the next 50 years will very likely be characterized predominantly as an age of biology and the exploration of the human organism, especially with the completion of the human genome project, which I think will literally explode what we know about how to deal with health issues."

A major goal of the genome project is to understand and decipher the human genetic code, identifying genes responsible for particular diseases.

Vice President Al Gore has been a strong supporter of high-technology projects at the health institutes. He has joined Donna E. Shalala, the Secretary of Health and Human Services, in seeking an increase of $1 billion for the agency in the fiscal year that begins on Oct. 1, and Administration officials said today that Mr. Clinton had agreed to that amount.

Patients' groups concerned about specific diseases, doctors and medical schools are forming a coalition to lobby for a 100 percent increase in the institutes' budget over the next five years. Terry L. Lierman, president of Capitol Associates, a lobbying concern, said today: "We plan a grass-roots campaign inside and outside the Beltway. It will be run the same way Northrop Grumman lobbies for the B-2 bomber."

Members of Congress said they would look to N.I.H. officials, rather than to the White House, for guidance as they decide this year on the appropriate level of spending for biomedical research. Dr. Klausner, the director of the National Cancer Institute, recently sent Congress a blueprint for spending $3.19 billion in the next fiscal year, up from the $2.55 billion provided to the cancer institute this year. "Knowledge about the fundamental nature of cancer is exploding," Dr. Klausner said.

The budget request, reflecting the professional judgment of Government scientists, includes these proposals: *The number of cancer research and treatment centers around the country should be increased to 70, from the current 57. *The Government should authorize "a fivefold increase over the next five years in the number of people participating" in clinical trials of new techniques for the prevention and treatment of cancer. At present, 300,000 people participate in such studies. The goal is "to insure that all people who wish to participate in a clinical trial are able to do so," Dr. Klausner said.

*Congress should provide an additional sum of $40 million next year so the Government can finance the top 40 percent of applications for research. The cancer institute says it now awards grants to the top 25 percent. (Applications are evaluated by panels of experts, through a competitive process of peer review.)

In appealing to Congress for more money, Dr. Klausner said the growth of managed care and other changes in the health care industry posed "a very real danger for the continuation of cancer research and our continued progress against cancer." Health maintenance organizations and other insurers are increasingly reluctant to pay even the costs of routine care for patients in early clinical trials, he said.

The cancer institute is seeking $60 million next year to subsidize the salaries of 600 scientists at the 57 cancer centers, so they will have more time for research.

Lawmakers said they would seriously consider such requests. "What we are doing today, making scavengers and beggars of the best in biomedical research, is just simply wrong," Senator D'Amato said.

Mr. Harkin, who wants to establish a Government trust fund for medical research, said: "Of the $1 trillion spent on health care in America every year, a paltry 2 percent is spent on research. The United States has spent more on Pentagon research and development in the last four years than we have on medical research since the turn of the century."