is based on a distillation of the ideas that were discussed at the
concluding plenary session of the workshop.
Medical research is an interdisciplinary, multi-agency effort involving
both the federal government and the private sector, and requiring
progress in many diverse fields of science and engineering to succeed.
Medical research should be defined in the broadest possible sense,
encompassing not only NIH but life sciences research in other agencies,
health care and health services research in the Department of Health
and Human Services, enabling research in other disciplines, and
infrastructure and facilities as well.
1. The primary source of federal funding for medical research
should remain within the discretionary portion of the federal budget
and should be allocated through established authorization and appropriations
processes. The existing appropriations process, while not necessarily
perfect, does exemplify the democratic process upon which the principles
of our government are based. While several potentially attractive
ideas for supplementary funding mechanisms were discussed, none
were seen as capable of replacing the current system.
also recognized, however, that it is not possible to accommodate
significant growth in research under the existing Balanced Budget
Agreement of 1997 without reductions in other important programs.
Some congressional leaders have stated, both explicitly and implicitly,
that the discretionary caps are likely to be ignored. It is essential
that lawmakers candidly and realistically address current limits
on discretionary spending as Congress completes action on the FY2000
2. A secondary source of funding, in the form of a trust or
reserve fund for medical research featuring a dedicated funding
source, in addition to the regular discretionary budget and perhaps
with appropriations review, could provide an important supplement
to annual appropriations. Potential sources for such a fund, which
could be employed either individually or in combination, could include:
from the existing state tobacco settlements, federal legislation
against tobacco companies on behalf of the Medicare program, and
taxes on the sale of tobacco products.
or taxes on private health insurance premiums. A portion of public
insurance premiums already goes toward graduate medical education,
for example, and legislative proposals exist to expand that to
private insurance payers. It may be worth pursuing a similar mechanism
to support medical research.
Fees on medical
products resulting from federally funded research, in the form
of payments in exchange for patent extensions. This funding source
would benefit from public and private-sector collaborations where
the private sector is able to generate a new product for commercial
sale. Medical research would benefit from increased revenue streams,
and the private sector would benefit from additional market exclusivity.
of funds within the existing highway trust fund to support research
in transportation-related injuries (e.g., spinal cord injury,
neural trauma, physical therapy).
3. Public and private insurance systems should be mandated to
pay the cost of health care services for beneficiaries participating
in federally-supported clinical trials, except in the case of trials
which are specifically linked to a patentable product or commercial
profit directly related to the outcome of the trial. There are many
instances where research trials are conducted for which there are
no derived products expected, and hence they receive no private-sector
support. Since these trials still generate knowledge, and contribute
to improved public health, an argument can be made that public and
private insurance funds should contribute. Therefore, funding for
federally-supported clinical trials should be absorbed or at least
shared by those who benefit from them.
4. The research and experimentation (R&E) tax credit should
be made permanent and expanded to include research in clinical trials.
Temporary extensions of the credit, as have been in effect during
the past several years, make it difficult for firms to use it in
a long-range manner. The basic research credit, which applies to
industry-academic research contracts, should also be restructured
as a flat rather than an incremental credit at a 20 percent rate
and enhanced with incentives in order to encourage greater collaboration
between private firms and academic medical centers.
1999 American Association for the Advancement of Science