Trends in Health-Related Research
Support for Research in the Life Sciences
Sciences Research within the Federal Research Portfolio
Figures are in PDF format.
and other health-related research has long been a priority for the
federal government, but in recent years the level of federal support
for medical research has expanded dramatically to become the largest
part of the federal civilian research and development (R&D) portfolio.
This paper examines historical trends in federal support of medical
research and places the federal investment in a variety of contexts,
including the relationship of medical research to research in other
fields and the overall budgetary context of federal R&D.
Trends in Health-Related Research
In the post-World War II era, the U.S. government has supported
a diverse and growing U.S. science and technology enterprise through
a decentralized, mission-oriented system that stands in sharp contrast
to the more centralized R&D allocation systems of most other industrial
countries. Almost two dozen cabinet departments and agencies support
R&D, and except for the National Science Foundation (NSF) no agency
supports R&D solely to advance science, in contrast to the more
centralized R&D allocation systems of most other industrial nations.
Rather, agencies support R&D to advance their missions as part of
a diverse portfolio of programs, and ideally each agency's R&D should
be tightly coupled to its mission and other ways of achieving the
a result, the primary supporter of health-related R&D in the United
States is the Department of Health and Human Services (HHS), which
funds Medicare, Medicaid, disease control activities, health training,
as well as research to advance its mission of improving Americans'
health. R&D accounts for only 5 percent of the department's total
budget. Budget decisions for health-related R&D are made in the
context of all HHS programs, and seldom systematically in the context
of other federal sponsors of R&D.
such a decentralized system, combined with a decentralized congressional
budget process in which R&D budget decisions are made by 9 different
appropriations subcommittees acting nearly independently, it may
appear impossible to set priorities or to allocate resources among
different R&D interests. Yet the beauty of the U.S. system is that
despite its decentralization, priorities do get set, and in the
post-World War II era one priority that has grown in importance
is health-related R&D.
1 shows federal support of nondefense R&D over the past four
decades by mission. The importance of various national missions
has changed over time, and these changes can be seen clearly in
the ups and downs of R&D funding. In the 60s, for example, funding
for space R&D increased dramatically because of the high priority
assigned to landing on the moon before the Soviet Union. Energy
R&D has closely tracked the nation's concern over dependence on
imported oil, with increased funding in the mid-70s and the early
80s and a decline in recent years.
support for health-related R&D, however, has grown consistently
over the past four decades. Although it was a relatively small part
of the R&D portfolio in late '50s and early '60s, federal support
has grown steadily since then and now accounts for the largest part
of the nondefense R&D portfolio. Even in the decentralized, loosely
coordinated U.S. system in which appropriations decisions are made
annually, health R&D has shown steady growth, reflecting the increasing
concern among the American people and their elected representatives
for finding new ways to prevent and cure disease.
primary supporter of health-related R&D within HHS is the National
Institutes of Health (NIH). Nearly 95 percent of HHS R&D is funded
by NIH.(1) The steady
growth in health-related research over the past decades has been
fueled by an aggressive expansion in the size of the NIH budget.
has enjoyed consistent popular, congressional, and presidential
support during the post-World War II era. Figure
2 shows that over the past fifteen years the NIH budget has
doubled in inflation-adjusted terms, with real increases nearly
has especially benefited from strong congressional support. Figure
2 also shows that nearly every year, Congress has added to the
amount NIH asked for in the budget request. The FY 1999 budget of
$15.6 billion for NIH (including non-R&D programs), for example,
is nearly $2 billion or 15 percent more than the FY 1998 budget,
and $815 million more than the agency's FY 1999 budget proposal.
For the last few years, the pattern has been the same: because of
the support of Republican champions of medical research as key appropriators,
each year NIH has won larger increases than most other R&D funding
agencies, and has won larger increases than the agency itself requested.
Despite the relatively tight budgets of recent years, congressional
support for NIH has if anything become stronger, and last year several
influential lawmakers publicly called for doubling the NIH budget
in five years, with the FY 1999 increase as the first installment.
So it is likely that the just-announced FY 2000 request for NIH
of $15.9 billion (an increase of 2 percent) will be a starting point
for congressional appropriators, and the final FY 2000 NIH budget
will likely be higher than that, perhaps as high as another 15 percent
increase, which would bring the NIH budget near $18 billion.
Federal Support for
Research in the Life Sciences
The steady growth in the NIH budget has had a dramatic effect
on federal support for medical research. Although figures for medical
research per se are not well defined, the closest approximation
is the category of 'life sciences research' in R&D funding statistics
compiled by the National Science Foundation.(2)
Figure 3 shows that in FY 1998, federal support
for life sciences research totaled $13.0 billion, of which the overwhelming
majority of support came from NIH, even though a dozen other agencies
provide support for life sciences research as part of their missions.
(DOE, for example, funds nearly a third of the Human Genome Project;
NASA funds life sciences in microgravity environments; DOD funds
cancer research). Many of these efforts have potential impacts on
human health. Apart from NIH, no other agency accounts for even
a tenth of the total life sciences portfolio.
addition to the above research in the life sciences (which, as the
chart notes, excludes development and R&D facilities), federal support
of R&D funds development and R&D facilities in health-related areas.
NIH, for example, funds development work on vaccines and medical
technology devices and also maintains state-of-the-art in-house
laboratory facilities. NSF provides some R&D facilities support
to universities and colleges to build life sciences laboratories.
Not surprisingly, trends in life sciences research mirror trends
in the NIH budget. Figure
4 shows that support for the life sciences has more than doubled
over the past three decades.
Life Sciences Research
within the Federal Research Portfolio
The trend in life sciences research is remarkable when contrasted
with how other disciplines have fared during this time period. Federal
support for engineering research, which was greater than life sciences
support in FY 1970, has stagnated for three decades. Support for
the physical sciences (physics, chemistry, astronomy, etc.) showed
slow but steady increases until the early 1990s, but has declined
steeply since then as a result of post Cold War restructuring in
the Departments of Defense and Energy. Among other disciplines,
only computer sciences and environmental sciences have shown any
growth in the 90s, although these increases come from far smaller
bases than in the case of the life sciences.
a result, the federal research portfolio is dramatically different
in FY 1999 than it was in FY 1970. Of the total federal research
portfolio of $33.0 billion in FY 1999, $14.4 billion (or nearly
44 percent) goes to life sciences research, compared with less than
30 percent in FY 1970. This dramatic growth for the life sciences
combined with flat funding or even cuts in the other sciences has
resulted in increasing concern within the scientific community that
the federal portfolio may be becoming unbalanced, with consequences
even for the advancement of human health. Harold Varmus(3)
, director of NIH, has warned:
Most of the
revolutionary changes that have occurred in biology and medicine
are rooted in new methods. Those, in turn, are usually rooted
in fundamental discoveries in many different fields. Some of these
are so obvious that we lose sight of them-like the role of nuclear
physics in producing the radioisotopes essential for most of modern
medical science. Physics also supplied the ingredients fundamental
to many common clinical practices-X rays, CAT scans, fiber optic
viewing, laser surgery, ECHO cardiography and fetal sonograms.
Materials science is helping with new joints, heart valves, and
other tissue mimetics. Likewise, an understanding of nuclear magnetic
resonance and positron emissions was required for the imaging
experiments that allow us to follow the location and timing of
brain activities that accompany thought, motion, sensation, speech,
or drug use. Similarly, X-ray crystallography, chemistry, and
computer modeling are now being used to improve the design of
drugs, based on three-dimensional protein structures. . . These
are but few of many examples of the dependence of biomedical sciences
on a wide range of disciplines-physics, chemistry, engineering
and many allied fields.
disparity between the life sciences and other sciences is even more
apparent in the nation's colleges and universities, which perform
nearly half of the total federal research portfolio, and a majority
of the basic research within that portfolio. Table A shows that
of the $24.3 billion in R&D performed by the nation's colleges and
universities in FY 1997, $13.6 billion or nearly 56 percent was
research in the life sciences. The federal government funds more
than half (57.9 percent) of the life sciences research in universities,
with the remainder coming from a mixture of institutional funds,
industry, nonprofits and foundations, and state and local governments.
Burgeoning federal support for life sciences research has resulted
in the dramatic expansion of medical research in academia and the
growth of large research complexes centered around universities'
In the past
few years, there have been more and more statements on the need
to achieve a more balanced federal research portfolio. The President's
FY 2000 budget proposal, as an example, calls for a modest increase
to NIH and larger increases to R&D programs in agencies such as
NSF and DOE, whose support is key to most non-life sciences fields.
The text of the proposal states, "This budget reflects an effort
to establish an optimum balance between health care research and
other scientific disciplines - a concern voiced in recent years
throughout the scientific community."
Even in the
medical research community, there have been recent statements on
the need to broaden federal funding beyond NIH and life sciences
research. The Federation of American Societies for Experimental
Biology (FASEB), a key lobbying group for medical research, recently
called for another 15 percent increase in the NIH budget for FY
2000, but also advocated a 15 percent increase in the NSF budget
and large increases for key DOE programs.(4)
Other organizations, such as the Association of American Universities(5),
have also increasingly articulated the theme that medical research
depends on advances in many disciplines, supported by agencies other
It is unclear
what, if any, effect these calls for balance will have on future
federal support for research. Because of the fragmented nature of
the federal budget process, it is difficult to make tradeoffs in
funding between NIH and other federal research agencies, so a zero-sum
game of cutting NIH to move funds to other R&D programs is unlikely.
The calls for balance mainly imply giving other agencies the same
or greater increases as NIH. This implied scenario pictures robust
federal support of life sciences research fed by an increasing stream
of enabling breakthroughs from other disciplines as a result of
increased research funding from non-NIH agencies.
Past trends are of course not predictors of future trends, even
considering the smooth, uninterrupted trend lines for medical research
in the past. Although NIH enjoyed the largest budget increase in
history in the final FY 1999 budget, there is no guarantee that
such success will be repeated in FY 2000 and future years.
First, all federal
R&D is funded out of the discretionary third of the federal budget,
which is subject to tight caps by the Balanced Budget Act of 1997
until FY 2002. The cap for FY 2000 is well below actual FY 1999
discretionary spending, partially because the Congress and the President
circumvented the tight FY 1999 cap through a variety of accounting
maneuvers. One reason the NIH budget request for FY 2000 calls for
a relatively small increase compared to recent years is that the
overall FY 2000 budget has to give at least the appearance of complying
with the FY 2000 cap. Although Congress may seek to give a larger
increase to NIH, lawmakers will have to fit any increases within
a constrained total discretionary budget or find, as in FY 1999,
mechanisms for circumventing or repealing the discretionary cap.
federal unified budget surplus is projected to grow substantially
over the next several years, including a projected $117 billion
surplus in FY 2000, neither the President nor Congress appears inclined
at the moment to use the surplus to finance additional discretionary
spending. Instead, the President and Congress favor using the bulk
of the projected surpluses to extend the solvency of the Social
Security and Medicare trust funds, while congressional Republicans
would also like to use them to finance tax cuts.
Second, as noted
earlier, there is no consensus on how to address the question of
a balanced portfolio for federal R&D. While the Clinton Administration
has made its statement on the subject with the release of the FY
2000 budget, it is unknown yet whether there will be public and
congressional support for boosting other agencies' R&D programs
and slowing down the growth rate in the NIH budget in the interest
of achieving a multidisciplinary R&D portfolio that may ultimately
have a greater positive impact on human health.
outcome of the FY 2000 budget, historical trends and current indications
of public and congressional support suggest that health-related
research will continue to have the strong support of government
policymakers. The big problems in the next few years, however, will
be translating popular support into dollars in a time of tightly
constrained discretionary spending, and figuring out what mix of
R&D programs and research areas will best advance the cause of improving
The remaining 5 percent comes from the Centers for Disease Control
(CDC), Health Resources and Services Administration (HRSA), Health
Care Financing Administration (HCFA), the Food and Drug Administration,
sciences research (excludes development and R&D facilities support)
includes research in biological sciences, environmental biology,
agricultural sciences, medical sciences, and other life sciences.
For more complete definitions, please see the publication Federal
Funds for Research and Development: Fiscal Years 1996, 1997, and
1998 (National Science Foundation, Dvision of Science Resources
Studies, NSF 98-332, 1998). See http://www.nsf.gov/sbe/srs.stats.htm.
Varmus, H. "New Directions in Biology and Medicine," AAAS
plenary lecture, Philadelphia, February 13, 1998.
Federal Funding for Biomedical and Related Life Sciences Research:
FY 2000 Recommendations, Federation of American Societies for
Experimental Biology, January 1999. See http://www.faseb.org.
"Biomedical Research Depends on Advances in Many Disciplines,"
Association of American Universities, January 1999.
1999 American Association for the Advancement of Science