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The future of federal support for health research.

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The Future of Federal Support for Health
The Honorable Joseph A. Califano, Jr., Secretary of the Department of Health, Education and Welfare (HEW) has recently initiated discussions and a
request for input related to the future of federal support
for health research. The hope is to develop, for the first
time, a multi-year strategy to guide allocation of limited
government health research dollars.
In his call for this coordinated effort, a number of
sobering facts were enumerated. Over the past 10 years,
federal support for basic research has declined by 19% in
constant dollars. The quality of scientific plants and
equipment at our great institutions has badly deteriorated. Research opportunities for young university scientists have been declining so that the percentage of
young scientists on our faculties has decreased from 43%
in 1968 to 27% in 1975. There were serious efforts in the
early 1970s to cut back on funding for biomedical research, under the guise of containing health expenditures. The total spent for biomedical research is
less than 4% of our nation’s health expenditures! It is
hoped that a multi-year plan will help to level out the
fluctuations in annual appropriations so that rational
research planning can be carried out.
Mr. Califano has outlined five basic principles
for discussion, the first three of which are hardly controversial. The last two, however, may be more difficult
to apply. These principles, as he presents them, are
merely illustrative; they are neither immutable nor exhaustive.
I n response to his request that appropriate interested health agencies provide comment in defining a
long-term strategy for future research efforts, an ad hoc
committee of the Arthritis Foundation met to provide a
broad initial response as it relates to research in the field
of rheumatology. A brief review of the response as submitted by this committee follows.
Principle 1 ; The most basic principle is to maintain
at a high level and to enhance HEW support for fundamental research into biology and behavior.
This principle was heartily supported. It was
urged that the integrity of the original mission of the
National Institutes of Health, namely the initiation and
Address reprint requests to David Shobe. Arthritis Foundation, 422 C Street, Washington, D.C. 20002.
funding of basic and clinical research and the preparation of investigators to enter these fields, should be
preserved. Efforts to involve NIH in behavioral research
beyond that defined within the context of classic basic
and clinical research, biostatistics, and epidemiology
should be approached with caution.
I t was suggested that improved continuity be accorded the missions of NIH so that research and training funds might be more reliably programmed, thereby
enhancing long-range planning and providing stability
to the work of research teams. Stability would encourage young investigators to remain in the field and entice
prospective investigators to enter biomedical research.
It was recommended that a higher percentage of
approved research applications be funded, so that projects receiving a priority score of 2.5 or better would have
a strong chance of being supported. Over the past 2
years, arthritis research has been funded at a priority
score of only 1.8 or better, leading to funding of only
30% of approved applications.
Strong attention should be given to separate
funding for replacement of equipment and physical
plants to provide adequate facilities for ongoing research.
Principle 2; Ample opportunities for young investigators must be assured.
NIH training programs for young investigators
should be given the highest priority. A return to the use
of NIH Research Training Grants rather than complete
reliance upon the current Research Service Awards was
recommended. Potential physician-scientists are often
discouraged from entering today’s research training programs because of the payback proviso, the lack of assurance of a position upon completion of their training,
and the instability of research funding. Career goals are
particularly difficult to accomplish for the investigator
who has no record of accomplishments upon which his
or her capabilities can be judged in competition with
more senior investigators. Special efforts should be initiated to train young scientists in the fields of epidemiology and behavioral research. At present, no epidemiologic research in arthritis is being funded by NIH!
Principle 3 ; Basic research has to be accompanied
by vigorous, thoughtful and, where appropriate, interdisciplinary applications.
Interdisciplinary research is of particular importance to the field of rheumatology since basic research
interests overlap with a number of other disciplines. In
addition, close collaboration between basic and applications researchers within the arthritis and related fields
is essential. In many instances it is not a lack of interest
that leads to a failure for such interconnections but
rather the lack of discretionary funds available to promote such studies.
Principle 4 : Government supported research must
have a strong orientation toward improving the quality of
our nation's health and efectiveness ofthis nation's health
The holistic approach to medicine has assumed
an increasing interest and importance. Recommendations relative to this principle are more difficult to answer, and indeed, the questions posed are often diffuse.
It is essential that the state of the art be more accurately
defined and that people expert in the field be adequately
trained before large sums of money be expended in this
area. Technology transfer in which basic science accomplishments are applied to clinical situations should
probably not be assigned as a primary mission to NIH.
Research projects in technology transfer should be subjected to the same rigorous scientific review and study as
basic and clinical research. Too many studies in this area
are either anecdotal or lack the application of scientific
Principle 5: H E W-supported research must be
more effectively oriented to develop knowledge bases that
suppport not just some but all the health missions of the
department-prevention, delivery, regulation, standardsetting and cost control.
The widespread distribution of research activities
in HEW makes it difficult to accurately gauge the need
for greater research capacity. It may be advantageous to
consider centralization of research activities under a
coordinator who, with appropriate assistance, could assess the best opportunities for arriving at answers to the
nation's health problems. Important considerations relate to appropriate emphasis on studies of chronic diseases. Priority funding for research should not be limited to diseases with high mortality, but should also be
provided for those diseases with high morbidity rates.
Support for basic research will, in the long run, diminish
morbidity and mortality, significantly lessening the need
for huge expenditures to care for disease already present.
Secretary Califano has proposed a cogent set of
principles for discussion. We commend his effort to
bring about an energetic exchange of ideas among the
research community, the government, the medical profession, consumers of medical services, and others. Debate and reassessment, looked at in positive fashion,
should be of substantial benefit to all involved.
Chairman, Government Afairs Committee
A rthritis Foundation
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