Do the allocations correspond to the conditions that most threaten the health of Americans? Not necessarily. In 1996, "a blue-ribbon panel appointed by the Institute of Medicine broke down [the funding] this way: For every $10 spent per cancer death on cancer research, $110 is spent per AIDS death on AIDS research and $3 is spent per heart disease death on heart disease research." But, heart disease has been the leading cause of death since the 1920s.3 According to Dr. Stuart Seides, a past president of the Washington American Heart Association, "those groups that speak the loudest or strike a particular note among the public or among legislators may get a proportion of the research dollar that is out of proportion to the number of victims of that particular disease."4 As of 1998, there was no organized lobby for heart disease.
This disparity in funding is not a recent phenomenon. The graphic below5 shows a history of 1999's top 7 causes of death. Since 1925, diseases of the heart killed the most people. From 1925 to 1955, two years after we began tracking funding, deaths from diseases of the heart increased nearly one and a half times as fast as deaths from cancer: 210.7% and 156.3%, respectively. But, funding for heart research (NHLBI) ranked 2nd to funding for cancer (NCI). From 1955 to 1985 the numbers reversed. Now, even though diseases of the heart were killing more people, the growth rate at which people were dying of cancer was nearly 3 times higher than the growth rate of people dying of diseases of the heart: 91.8% and 31.7%, respectively. From 1985 onward, the numbers of people dying of cancer continued to rise. At the same time, the number of people dying of diseases of the heart declined. And funding for cancer (NCI) remained in the lead.
Historical Data for the Top 7 Causes of Death in 1999
But, the NHLBI does not just research diseases of the heart, its treatments, and its cures. It also researches the causes, treatments, and cures for cerebrovascular diseases (stroke) and chronic lower respiratory diseases (asthma and emphysema), the 3rd and 4th causes of death in 1999 respectively.
Until the mid- to late-1980s, diabetes and digestive and kidney disorders (NIDDK) research was the third most funded. Diabetes was the 7th leading killer in the United States until 1999 when it became the 6th leading cause of death surpassing influenza and pneumonia. After 1987, NIDDK dropped in rank and became the 5th most funded institute under the NIH.6 This, despite the rise in the number of diabetes cases since at least 1990.
From 1987-1988, genetic research (NIGMS) ranked third in funding. After this, however, it dropped to 4th behind allergies and infectious diseases (NIAID). Besides genetic research, this institute studies the interactions of biological, physiological, and pharmacological processes on diseases and other medical conditions. Therefore, its research may have an impact on every aspect of medical research done at the other NIH institutes. From 1989 onward, this institute's funding rank dropped to 4th.
Once ranked 5th, funding for allergies and infectious diseases (NIAID) moved up to 3rd place in 1990. Perhaps this was in response to the growing concern about AIDS in the U.S. and around the world. Celebrities who had the disease began speaking out. President Reagan commented on the disease for the first time in 1990.7 That same year, nearly 200,000 people were living with HIV, an increase of nearly 1,700% since 1984, and the numbers rose for another 2 to 3 years.
NIAID is also concerned with finding the causes, treatments, and cures for new diseases, and older ones that are becoming resistant to the medicines we traditionally used to treat them.
What will happen in 2003? Why is the proposed funding for allergies and infectious diseases rising so much? (That would then rank NIAID second in the amount of funding it receives from the NIH.) Is there a new epidemic on the horizon? This $1.5 billion increase in funding8 is due in large part to the events of September 11, 2001 and the anthrax scares in the subsequent months. This increase in funding, along with an extra $1.2 billion that NIAID expects to allocate from other funds is to go into bioterrorism research. The Institute, anticipating long-term funding, is launching research campaigns to study anthrax, tularemia, plague, botulism toxin, and hemorrhagic fever viruses. Its efforts will also go towards researching E. coli and staphylococcus bacteria. Their goal is to discover vaccines or better medications to combat these illnesses (should we ever need them).
Sources: Chart data: National Center for Health Statistics. Centers for Disease Control. U.S. Department of Health and Human Services. Historical Data Table HIST290A. Retrieved August 9, 2002 from http://www.cdc.gov/nchs/data/statab/; National Center for Health Statistics. Centers for Disease Control. U.S. Department of Health and Human Services. National Vital Statistics Report, Vol. 49, No. 11, October 12, 2001. Retrieved August 9, 2002 from http://www.cdc.gov/nchs/data/nvsr49/nvsr49_11.pdf. NIAID 2003 funding and research information: Dr. Anthony Fauci, MD. "An Expanded Biodefense Role for the National Institutes of Health," April 2002. Retrieved August 9, 2002 from http://www.homeland-security.org/journal/Articles/fauci.htm. Individual institute information retrieved from their respective websites: http://www.cancer..gov, http://www..niaid.nih.gov, http://www.nhlbi.nih.gov/, http://www.nigms.nih.gov, and http://www.niddk.nih.gov. Louise Schiavone. "Cancer rally calls attention to the politics of medical spending." CNN interactive, September 25, 1998. Retrieved August 13, 2002 from http://www.cnn.com/HEALTH/9809/25/cancer.march.advancer/. Office of the Assistant Secretary for Planning and Evaluation. U.S. Department of Health and Human Services. "Physical Activity Fundamental to Preventing Disease," June 20, 2002. Retrieved August 27, 2002 from http://aspe.hhs.gov/health/reports/physicalactivity/.
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