Even in this tough budget year, Congress's infatuation with medical research is about to deliver another large increase for the National Institutes of Health, which has now ascended to the sacrosanct status of the Pentagon at the height of the Cold War.
The NIH's budget gain is extraordinary, and so is the absence of questions about NIH's priorities, as well as its share of government money for civilian research--nearly 50 percent and rising. The NIH budget has grown from $11.3 billion in 1995 to $15.6 billion this year, with another billion or two on the way from the current Congress. Much more is expected, given wide support for proposals to double the NIH budget over five years.
The growth is in part attributable to NIH Director Harold Varmus, whose deft administration and Nobel halo have captivated Congress. But also at work is a bipartisan suspension of judgment and absence of scrutiny in the face of heavily lobbied public appeals for cures and far-fetched scientific promises of delivery.
Sensible citizens can agree that if Washington is going to squander money, let it be on the health sciences. But we can do better than that. With medical research depicted as a "war" on disease, and claims of wondrous developments coming from NIH and the scientists it supports in universities and hospitals, questioning of the grand enterprise is a political blasphemy. But doubts have been expressed by a few skeptics, led by the late representative George E. Brown Jr., a longtime member and former chairman of the House Science Committee.
An unalloyed science enthusiast, Brown came to be known as "Mr. Science" of Capitol Hill, but he retained a capacity for skepticism. Two years ago, Brown noted that NIH's spending priorities failed to reflect the fact that "most of the major health problems facing society are driven by behavioral choices: Smoking-related diseases, alcohol-related diseases, diet-related diseases, suicide, homicide, accidents and AIDs from IV drug use and unprotected sex lead the list."
"If we were using this priority list to drive health research," Brown continued, "we would create a very large Institute of Behavioral Sciences to capitalize on the high public health payback from changed lifestyles. We would place less research emphasis on elegant curative approaches and put a higher priority on mundane behavioral modification."
At NIH, where molecular-level research is king, and behavioral research gets budget crumbs, the message bounced off without effect. Recently another try was made in the Senate, where the Appropriations Committee plaintively observed that NIH "has never fully incorporated behavioral research as part of its core public health mission."
Brown also raised the sensitive issue of the growing financial disparity between the politically popular medical sciences and other disciplines, such as chemistry and physics, that are less glamorous but important for many purposes,including medical research. NIH Director Varmus has also sounded this theme, and NIH has recently shared some of its financial good fortune with the sagging field of physics. But the disparity continues to grow.
Brown raised other uncomfortable questions: Do the heavily hyped medical sciences realistically hold such great promise that their growing share of government science money is justified? Is the rapid budget growth sustainable, or is it exposing NIH to the boom-and-bust cycle that hit defense-supported research earlier in this decade?
The privileged status of NIH is evident in the absence of congressional interest in examining these matters. Packed with lobbyists pushing for money for medical schools and for research on specific diseases, annual hearings on the NIH budget are mutual-admiration performances featuring fawning legislators and politically savvy NIH administrators. The think-tank industry follows the money, and therefore does not scrutinize the workings of government-supported medical research. The press concentrates on medical discoveries financed by NIH, with scant attention to its priorities or bureaucratic workings.
With Brown gone, the hallelujah chorus dominates the stage. That's unfortunate, because medical research is too important to be free from critical scrutiny.
The writer is a science journalist.