Funding Priorities Under Scrutiny

A study published in the June 17 issue of the New England Journal of Medicine takes a look at how funding by the federal government correlates with the costs—both in financial and human terms—of a disease. Always a difficult and contentious subject to tackle, this study will add to the continuing national debate on how the woefully inadequate federal research budget should be allocated.

In this study, principle investigator Cary Gross from Johns Hopkins University School of Medicine (Baltimore), attempted to determine the relationship between the funding level of 29 diseases and the burden of the diseases according to six different measures: the prevalence of a disease (how many people are affected by it), its incidence (how many new cases in a year), mortality figures, the number of years of life lost, number of hospital days, and a new index of the disabling effects of a disease, which he terms DALY (disability adjusted life years).

Gross found that no one factor—not even death—can explain the burden of disease or justify funding level. There was no correlation between funding and incidence, prevalence and cost in terms of hospital dollars. Funding levels correlated only weakly with deaths, and the age of those affected. But the strongest correlation was with DALY.

Overall, the funding level of a disease appeared to be related to the burden associated with it. However, the conclusions drawn were different depending on the measure being applied. For example, using death as the factor when looking at a disease like depression that causes few deaths, the funding level appears high relative to other diseases. However, when instead the disability factor is considered, it comes out underfunded.

Using the three measures that correlated best with funding, Gross found that the best-funded diseases currently are AIDS, breast cancer, dementia, diabetes, and heart disease

Not surprisingly, advocates for disease foundations were quick to point out the complexity of conducting a study of this kind, and disputed such conclusions. Not factored in, for example, was the fact that research results frequently have implications and applications beyond the disease that was the object of study. An AIDS activist interviewed on National Public Radio said she finds pitting diseases against each other counterproductive and shortsighted.

In an accompanying editorial in the journal, Harold Varmus, director of the NIH, found the correlation between the burden of the disease and NIH funding reassuring, yet pointed out huge discrepancies in funding—as much as 10-fold—among diseases with seemingly similar burdens. He provides several explanations for this discrepancy: inherent limitations in the DALY calculation used, inconsistencies in the method for coding research dollars, and the effect of funding by complementary agencies or pharmaceutical companies on the NIH budget for some diseases.

For more information: Cary P. Gross, Johns Hopkins School of Medicine, 720 Rutland Ave., Baltimore, MD 21205. Tel: 410-614-4523. Email: cgross@welchlink.welch.jhu.edu.

By Laura DeFrancesco