Dilemmas of NIH Funding for Cardiovascular Research
Should the National Institutes of Health (NIH) allocate more research dollars for cardiovascular diseases (CVD)? According to a recent Institute of Medicine (IOM) study entitled “Scientific Opportunities and Public Needs: Improving Priority Setting and Public Input at NIH,” many other diseases that claim fewer lives are funded at much higher levels by the NIH.
The study was mandated by the US Congress, who do not regard themselves as equipped to set the research-funding priorities of NIH, an agency headed by a Nobel laureate in medicine, staffed by scientists, and ideally advised by formal and informal groups of many of the nation’s leading researchers. However, for several reasons outlined in the report (the increasing centralization of decision making in the NIH director’s office, for example), national nonprofit groups that represent specific diseases have been turning more and more to members of Congress, bombarding them with heartfelt and typically legitimate arguments for more NIH research funding for specific diseases.
And the result, according to the IOM report, is that some members of the US Congress have questioned the NIH decision-making process. They “point to widely different amounts of research funding per afflicted person from one disease to another. … They also note that the largest amounts of NIH funding do not always go toward research on diseases that cost the federal government the most through the Medicare program,” says the report.
The number of people afflicted by a disease is only one of several factors that influence the decisions of the NIH about levels of research funding. Because the number of people with the disease is an important factor, the IOM panel recommends that the NIH strengthen “its analysis and use of health data, such as burdens and costs of diseases, and of data on the impact of research on the health of the public.” And, according to the panel report, the NIH should improve its communications to the public about these data and include more representatives of the public on its decision-making bodies, so that the public’s voices, as well as the opinions of the scientific community, can be heard and considered. In his presentation to the IOM panel conducting the study, AHA national science volunteer Dr Michael Rosen of Columbia University’s College of Physicians and Surgeons called for “new mechanisms to enhance public input. … The AHA believes that there is little opportunity for public input into the NIH priority setting process.”
AHA leaders have been very concerned about the relatively low level of NIH funding for CVD research. But our goal is to work with the NIH, not against it. It is essential that we work together to correct this funding dilemma. Many lines of communication are now open. Along with several AHA science volunteers, I’m in constant contact with Claude Lenfant, MD, Director of NHLBI. We are trying to synergize AHA’s and NHLBI’s efforts to better serve our common goal of fighting cardiovascular disease. AHA science volunteers and I have also talked with Harold Varmus, MD, the director of the NIH. We have their attention, their interest, and their concern.
Although the AHA argues that more NIH dollars should be invested in CVD research, the AHA is opposed to reductions in the NIH research budgets for other diseases to increase funding for heart disease and stroke research. The entire budget of the NIH should be increased significantly. Indeed, Research!America, a coalition of health advocacy groups that the AHA joined under the 1997–1998 AHA presidency of Martha Hill, RN, PhD, of Johns Hopkins University, has called for doubling of the NIH budget in 5 years. In its advocacy efforts for more NIH funding, the AHA calls for a 15% increase in the NIH budget each year until the doubling of the budget is achieved.
For many of us who are committed to the AHA’s mission of reducing death and disability from CVD, the amount of NIH funding for heart disease and stroke research has been somewhat puzzling. Jan L. Breslow, MD, of Rockefeller University, had the vision during his AHA presidency (1996–1997) to create a slide program entitled “Myths about Heart Disease and Stroke” for AHA volunteers to use in presentations to awaken the public’s interest, concern, and indeed justifiable fear of CVD. The myths highlighted were that “heart disease is going away,” “living with heart disease is not so bad,” “heart disease is a good way to die,” “only older people have strokes,” “women don’t get heart disease,” and “no more research is needed.”
The first myth—“heart disease is going away”—is the one that perhaps has had the greatest impact on NIH funding decisions. In countering this myth, Dr Breslow pointed out that although the age-adjusted death rate for coronary heart disease (CHD), the most common form of cardiovascular disease, has been declining, “the age adjusted death rate tells only part of the story.” When the NIH updates the age-adjusted death rate, which is now based on the 1940 population, to the year 2000, the currently cited death rate for CHD will almost double because of the “aging” of the population. In the early part of the 21st century, CHD will jump from fifth to first place in the World Health Organization’s list of causes of death and disability worldwide. Clearly, CHD is not going away.
Neither is stroke, another form of CVD of great concern to the AHA. After declining for many years, stroke deaths are rising. As presented at the AHA’s 23rd International Joint Conference on Stroke and Cerebral Circulation in February 1998, recent studies indicate that the incidence of stroke in this country is 40% higher than “official” estimates. The aging of the population also will result in more than double the number of stroke victims per year by 2050.
By supporting initiatives to double the NIH budget and working with leaders of the NIH in our efforts to bring the scientific opportunities in CVD, we will reach our goal of more research dollars for CHD and stroke and more effective approaches to reducing death and disability from these diseases.
Dr Fuster is director of the Cardiovascular Institute of Mount Sinai Medical Center in New York, NY.
- Copyright © 1998 by American Heart Association