- The Washington Times - Monday, January 21, 2002

Despite shrinking government revenue, President Bush plans to fulfill his promise to complete the process of doubling the federal medical research budget over five years.

That's the good news. The bad news is he may be reigniting rivalry among disease groups by arbitrarily ordering that cancer research get a much bigger financial boost than other diseases.

And there's more bad news in Mr. Bush's failure, after a year in office, to name a permanent director of the National Institutes of Health.

Four of NIH's individual institutes, covering neurology, mental health, and drug and alcohol abuse, also lack permanent directors, as does the Food and Drug Administration (a separate agency).

Scientists, disease groups and members of Congress say the empty directorships result in a "lack of leadership" for the agencies at a time when key decisions need to be made on bioterrorism, stem cells, cloning and scientific priorities.

Either because the top jobs are vacant or because it's his management style, scientists say that Health and Human Services Secretary Tommy Thompson is consolidating administrative, public relations and congressional liaison authority in his office, raising accusations of "micromanagement."

For NIH director, Mr. Thompson reportedly has sent the White House the name of Anthony Faucci, director of the National Institute of Allergy and Infectious Diseases; but no decision has been made.

Mr. Faucci, highly visible on television as a lead administration spokesman on bioterrorism, is a popular choice among scientists and disease activists. He also led NIH's highly successful AIDS research.

But it's believed that his requirement for taking the top NIH job keeping his NIAID directorship may be unacceptable to the White House.

Conservative Republican senators reportedly are pushing for infectious disease specialist Robert Redfield, of the University of Maryland, to head NIH.

According to White House budget director Mitch Daniels, Mr. Bush's new budget will contain "on the order of $4 billion new dollars" for NIH, "finishing the president's commitment to double the budget over five years." Mr. Daniels said Mr. Bush's budget also would give a healthy boost for research on defense, energy and the physical sciences.

NIH will receive a budget increase of roughly 15 percent, officials say, while most other federal civilian agencies will be held to 3 percent or 4 percent, as the top priority in tough economic times is going to be the war on terrorism and homeland security.

Homeland security priorities especially the need to fight bioterrorism will affect the NIH budget too, producing a whopping 60-percent or larger increase for Dr. Faucci's infectious disease institute, which currently spends $2.4 billion.

Disease group representatives say they understand the need to fight bioterrorism with research money, even though it takes funds away from other priorities. They are in an uproar, however, over reports Mr. Bush has unilaterally ordered a 21-percent boost in NIH's cancer budget while holding increases for other diseases to 6 percent or 8 percent, down from 14 percent or 15 percent in previous years.

Administration officials say the funding gap won't actually be that great because the National Cancer Institute will get an increase of between 10 percent and 15 percent, while other institutes will get increases "in the 8 percent or 9 percent range."

During the 2000 campaign, Mr. Bush not only promised to complete the doubling of NIH's budget by fiscal 2003, but also to wage a new "war on cancer" and increase NCI's funding to $5.1 billion, which would require a $900 million, or 21 percent, increase next year.

Mr. Bush gave cancer research no advantage over other diseases in last year's budget, but administration officials confirm he will in this one by not only increasing NCI's funding but ordering increases in cancer research by other institutes.

According to reports, Mr. Bush was urged to launch a new "war on cancer" by his parents, the former president and first lady. The Bushes lost a daughter to leukemia in childhood.

Favoring cancer over other illnesses, however, inevitably will reduce budgets for other diseases and is likely to set off a rivalry among disease groups that have been united around the goal of "lifting all boats" by doubling the whole research budget.

"We're grateful for the overall budget increase," said Kevin Mathis, director of the Campaign for Medical Research, "but it's bad procedure to politically single out a specific disease for extra money.

"If the administration starts earmarking for specific diseases, there's no way you can stop Congress from earmarking, and various disease-specific groups from lobbying for earmarks."

Ideally, scientists at NIH should set funding priorities based on scientific opportunity the chances of conquering a disease and on public health needs.

Presidents, members of Congress and disease groups do agitate for "earmarks" Bill Clinton provided extra funding for breast cancer and AIDS to reward favored constituency groups, for example but it's divisive and may misdirect science.

Cancer, the nation's second-deadliest disease, already is the best-funded of all research targets, with a budget more than double that of heart disease, the nation's No. 1 killer.

Almost as many people suffer from diabetes as from cancer, and diabetes kills 200,000 people a year, compared with 550,000 for cancer. Yet, the cancer budget is more than 6 times higher.

A strong NIH director might be able to persuade Mr. Bush to let science, not personal preference, set the budget. But first, the president has to appoint one.

Morton Kondracke is a nationally syndicated columnist.

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