Polishing the crown jewel agency: justifiable funding boost

It’s often said that Americans are losing faith in government. I’m not sure they ever had that much faith in government to start with. Complaints about unmanageable and inefficient bureaucracies have abounded for as long as I can remember.

America’s distrust of big government sometimes seems especially explicit when it comes to healthcare. Our healthcare status is so personal and important to our well-being that we’re understandably skittish when it comes to government oversight in this sector.

The area of medical research is one of the few for which Americans largely trust that the government’s role has a positive effect. Of all the offices and agencies that exist to address healthcare needs in this country — the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Food and Drug Administration and many others — the National Institutes of Health is arguably the most trusted and most respected.

While other agencies are commonly criticized for excessive bureaucracy, ineffectiveness or wastefulness, it’s rare to hear a member of Congress berate the NIH for shirking its mission, or failing to live up to the expectations of the American public.  This agency’s reputation, and its perceived effectiveness and importance as a public good, is largely why it was singled out by a Republican majority to have its budget doubled from 1999 to 2003. Since then, very small increases in the budget have left disease advocates and scientists in a position of advocating for significant funding growth at this crown jewel of an agency.

The current NIH budget hovers around $29 billion. While most Americans believe that more healthcare dollars should go to research, it turns out that the U.S. spends a larger percentage of our healthcare dollars on biomedical research — through NIH, private industry and other sources — than any other country.

Like many of my colleagues, I believe that we should enhance our commitment to fund reasonable increases at NIH. Surely there are other programs that could be scaled back in order to make this commitment budget-neutral.

But the battle to fund the life-saving research of the future isn’t just a funding battle. It matters a great deal how limited dollars are spent, what sorts of research projects are emphasized, and perhaps most importantly, how research findings are translated into clinical treatments for patients. In 2006, Congress passed the NIH Reform Act, which made several fundamental changes to the way that we fund the NIH, and how much discretion the NIH director has over the budgets of the 27 institutes and centers.

Perhaps the most notable accomplishment of this law was the creation of a Common Fund — a dedicated pot of money to be used for the purpose of “trans-NIH” research — projects that involve the collaboration of two or more institutes. As science progresses, more disease-solving emphasis is placed on unlocking the secrets of the human genome. Traditional distinctions between diseases and organ-specific ailments are becoming blurred.

As lawmakers, we have a responsibility to allow science to progress in the most efficient, cost-effective manner possible. The urge to create new structures and programs for particular diseases is a difficult one to manage. There are so many diseases that appear to get the short shrift when it comes to research, and often the most obvious solution is to mandate dedicated funding streams and new grants to address the disparity. Patient groups, quite understandably, lobby members on these bills, believing that they will result in the cures of the future.

But proposals like these have to account for the direction of science, and how the NIH works. As NIH Director Dr. Zerhouni said in a recent hearing, “…We are discovering similar genetic variations occurring among multiple diseases, such as cancer and Type 2 diabetes. This convergence of science strongly suggests that cross-cutting, multi-disciplinary research, unencumbered by arbitrary structures and narrow approaches, is the critical way of advancing medical research.”

This doesn’t mean that Congress should shirk its responsibility to oversee the research that goes on at the NIH. It’s critical that we ensure that current law is implemented, and that our constituents have a voice in the taxpayer-funded research portfolio. We shouldn’t cede our authority to make improvements to the executive branch.

There are research and patient care questions that should be addressed at a broader level — involving all federal public health agencies. For example, are we doing everything we can to get research findings quickly into the hands of doctors who are treating patients? How do we encourage high-risk, high-reward research so that innovative scientists get funded? How do we improve the speed and proficiency of drug and device approval? Efforts to address these questions will ultimately benefit patients with a wide array of diseases.

Myrick is a member of the House Energy and Commerce Committee.