A second look at NIH spending priorities

By MARK McCARTY

Medical Device Daily Washington Editor

A couple of weeks ago, I posted something to this blog about NIH spending and whether it made sense, but there are other ways of doing the accounting. As I mentioned on May 1, the amount said to be allocated for the National Cancer Institute for fiscal 2010 was slightly more than $5 billion whereas the National Heart, Lung and Blood Institute took in about $2 billion less. This stands in contrast to the respective burdens of these disease groups, which is roughly $475 billion for heart disease in 2009 and $228 billion for cancer the previous year.

The disparity is even more pronounced for Alzheimer's contrasted with cancer. As also noted in the previous blog posting, the Alzheimer's Association (Chicago) pegs the cost of care for Alzheimer's at $20 trillion between 2010 and 2050 (click here), an average of $500 billion a year. That's one fourth the money ($1.6 billion) plowed into cancer research, but twice the cost to society.

If we look at the numbers from a different angle, do they change much? We're going to find out.

NIH has an online reporting mechanism titled the NIH Research Portfolio Online Reporting Tool (RePORT). This mechanism provides estimates of the amounts applied to research areas, which consist in some instances of individual disease states and in other instances, groups of diseases.

According to the RePORT data, the “support level” for Alzheimer's in the current fiscal year is set for $450 million, with that number expected to rise by $8 million in fiscal 2012. Now as everyone knows, that number – in fact, all these numbers – are subject to revision as the 2012 budget impasse drags on, but these are the numbers we have. Still, this is a lot less than the $1.6 billion listed for Alzheimer's and other neurocognitive disorders in our previous analysis.

The RePORT numbers for heart disease include a vaguely titled category called cardiovascular, with a bit more than $2.1 billion indicated for FY 2011 and just enough additional funds for the following year to round up to $2.2 billion. Another category titled “heart disease” calls for $1.3 billion and $1.4 billion this year and next, while the bucket bearing the title “heart disease – coronary artery disease” is slated to take in $457 million and $465 million. Atherosclerosis is set for $544 million and $553 million in these two years, which presumably benefits peripheral artery disease as much as the center of the circulatory system, but we'll throw it in this bucket anyway.

For fiscal 2011, these add up to about $4.4 billion for this fiscal year and perhaps a dash more than $4.5 billion in FY 2012. That's substantially more than the sums I described earlier for heart disease, but let's see how it holds up against the numbers for cancer in all its stripes.

There are a number of cancer categories to be listed, including brain cancer ($274 million in fiscal 2011 and $279 million in fiscal 2012), breast cancer ($763 million/$778 million), and just “cancer” ($5.8 billion/$5.9 billion).

Throw childhood leukemia ($54 million/$55 million) into the mix, along with colorectal cancer ($291 million/$297 million), lung cancer ($201 million/$205 million), liver cancer ($102 million/$104 million), and prostate cancer ($331 million/$337 million). Uterine cancer comes in at $25 million both years.

The numbers tally to $7.8 billion for the current fiscal year invested in cancer research at NIH, and $8 billion in fiscal 2012 compared to $4.4 billion and $4.5 billion for heart disease, with heart disease imposing twice the cost on the U.S. economy.

We could comb over additional grounds, but I think the point is made. Spending at NIH is nothing short of bizarre when you compare the amount plowed into research to the costs of these diseases.

Are there other ways of looking at this? I'm sure there are. Let's hear about them!