Beating heart disease

Pink ribbons remind women of breast cancer, and the Red Dress Pin is doing the job for the nation’s No. 1 killer, heart disease.

“Not too many years ago, we thought of heart disease as a disease of middle-aged men,” says Dr. Stuart Seides, associate director of cardiology at the Washington Hospital Center in Northwest. “A very different human face has been put on heart disease. I think that’s what shakes the dollars out of the rafters.”

NIH’s National Heart, Lung and Blood Institute and partner organizations are sponsoring the Heart Truth campaign this year with pins and free risk-factor screenings to increase women’s awareness of a disease that, according to the American Heart Association, claims the lives of up to a half million women a year.

Government agencies and private institutions fund research, treatment or prevention of diseases whether or not they receive the limelight or are a top cause of death. The top causes in 2001, after heart disease, included cancer, stroke, chronic lower respiratory diseases and diabetes, as identified by the latest information from the Centers for Disease Control and Prevention’s National Center for Health Statistics.

Several metro-area health professionals say funding amounts lag behind the needs for these top diseases, pointing to heart disease, cancer and diabetes, which remain among the top 10 causes of death, they say.

“Funding priorities are not based on simple raw numbers of death,” says Dorraine Watts, who holds a doctorate in biostatistics and research design. She is also the executive director of research for Inova Health System at Fairfax Inova Hospital in Falls Church. “You have to look at which groups are dying, but you also have to look at which groups are affected.”

Funding for the National Institutes of Health (NIH) and the CDC in the Department of Health and Human Services (HHS) come from Congress, which sets funding priorities and amounts for the two agencies.

NIH distributes research funds according to the number of people who have and who die from each type of disease, the degree of disability a disease causes, its potential danger to public health and its associated economic and social costs. NIH funds medical and behavioral research to help diagnose and treat disease and disability.

Alternatively, CDC focuses funding on protecting people’s health and safety and providing disease prevention and control. The agency distributes funds based on the causes of death from diseases and infections, the rate they can spread, the likelihood they can be treated and prevented and the access to care for underserved populations at risk.

“We are, of course, interested in and work on the things that are currently causing illness, disability and death,” says Dr. Dixie Snider, acting deputy director for public health science at CDC, which is based in Atlanta. “We also have to think about what has been and what could … potentially happen that we need to prepare for.”

Heart disease, the top cause of death and disability among Americans, receives less funding from CDC and NIH than do several other diseases, including cancer, infectious diseases and AIDS/HIV, though heart disease is the No. 1 killer across all genders, age groups and races, Dr. Seides says.

“There’s a mismatch between the funding for research and the incidence and importance of cardiovascular disease, both locally and nationally,” he says.

The main reason, Dr. Seides says, is the political disadvantage the disease has to other diseases, such as breast cancer and HIV/AIDS, which are supported by lobbying efforts and “a strong political constituency.”

In fiscal year 2003, NIH provided $2.01 billion for heart disease research and another $2.24 billion for cardiovascular research from its $27.06 billion budget. The largest funding category, $5.43 billion, went to cancer research, as outlined in a table that lists estimates for diseases, conditions and research areas that, in some funding categories, are included more than once. Diabetes was funded at $910 million and HIV/AIDS, $2.71 billion.

“NIH has to go back to the drawing board and re-evaluate its methods for distribution and stop the favoritism toward AIDS,” says Richard Darling, president and chief executive of the Fair Allocations In Research (FAIR) Foundation, a California-based nonprofit organization he founded in 1992 to promote fair and equitable distribution of NIH research funds.

NIH provides more funding per person for HIV/AIDS research than the top diseases that kill men and women, he says.

Likewise, CDC provided $976.16 million for HIV/AIDs in fiscal year 2003, compared to $232.74 million for breast, colorectal, ovarian, prostate and skin cancers combined; $63.34 million for diabetes; and $42.96 million for heart disease and stroke. CDC’s budget that year was $6.98 billion.

AIDS is one of the top 10 causes of death for at-risk populations and, in 1999, was the fifth-leading cause of death for Americans between the ages of 25 and 44, according to CDC.

“Congress makes the final determination in how much money we get for these various diseases,” Dr. Snider says. “There’s not necessarily going to be, from our perspective, a match between what is appropriate for us and how many cases [there are] of the disease.”

Dr. Stephen Clement, program director of the Diabetes Center at Georgetown University Hospital, says diabetes, the No. 6 killer, is being “underfunded.”

Eighteen million people are diagnosed with the disease, a number that increases by about 1 million people a year, attributed, in part, to sedentary lifestyles, poor diets and obesity, Dr. Clement says. “From a budget standpoint, diabetes could break the bank for medical care in the next few years if the trends continue,” he says.

In the case of funding cancer research, the basic sciences, such as pharmacology, physiology and immunology, receive “fairly good support,” says Dr. Lawrence Lessin, medical director of the Washington Cancer Institute at the Washington Hospital Center. “While overall funding has increased significantly over the last decade, in order to fully explore the potential clinical benefits derived from scientific advances, more funding will be required.”

Funding for clinical research, which involves the development of new drugs and the testing of treatments through clinical trials, does not cover all of the costs of research, so funding from other sources is needed, Dr. Lessin says.

“There are many new discoveries and new ideas. Funding is required to test these ideas,” he says.