THE PAINFUL POLITICAL TRUTH ABOUT MEDICAL RESEARCH
Spending for research on major diseases, such as cancer, heart attacks, and AIDS, arouses intense emotions because life-and-death choices are involved. Unfortunately, the distribution of funds among diseases deviates greatly from the socially most desirable allocation that would give the greatest overall benefit. The money is misallocated, in large part, because well-organized advocacy groups for particular diseases, such as AIDS, use their political clout to get disproportionate shares of the research budget.
Almost all federal spending on medical research in the U.S. is funneled through the National Institutes of Health (NIH), which has a budget of about $12 billion. Diseases that cause a greater number of deaths should, and generally do, get more research dollars. However, the amounts spent per death are very different: NIH funding is over $4,000 per death from cancer, but only a little above $2,000 per death from heart disease--which causes about 50% more deaths than cancer does.
Some illnesses may receive proportionally more funding because they cause more pain and suffering, because there are better prospects for important research advances, or for other relevant reasons. However, it is not easy to justify certain allocations. For example, NIH spending on breast cancer research is about five times the spending on prostate cancer, even though they are the two most important cancer killers. They cause about the same number of deaths per year, although only men have prostate problems, and breast cancer almost entirely strikes women.
YOUNGER VICTIMS. Breast cancer research is so much better funded partly because sufferers are better organized for political activity. They have pressured the federal government into allocating more of the research budget to the illness. Men have tended to keep quiet about their prostate cancers, but they have become more outspoken in recent years.
Greater research on breast cancer may be partly justified by the fact that women who die from it are much younger than male victims of prostate cancer. However, higher spending on prostate than on breast cancer would help narrow the already large gender gap in life expectancy: Women tend to live about seven years longer than men.
The much smaller funding of research on prostate cancer cannot be explained by the difficulties of making medical advances in this field, since prostate and breast tumors are considered to be rather similar medically. Moreover, CaP CURE, an organization set up by Michael R. Milken a few years ago to fight prostate disease, has been inundated with applications from researchers. Hundreds of grants have been awarded, yet the directors of the foundation believe that many other promising proposals had to be turned down because they lacked funds.
PROGRESS. Prostate and lung cancers are the only two major cancers with sizable increases in death rates since President Richard M. Nixon declared the war on cancer in 1972. The growth in lung cancer is due obviously to heavy smoking in the past, while the lack of federal funds for research on prostate disease helps explain why treatment of more advanced forms of prostate cancer was unchanged for over half a century. But due to the private funding from CaP CURE, there is now excitement that major progress in combating this disease may be close at hand.
Compared with other diseases, AIDS research is supported extremely generously. The NIH allocates about 10% of its research budget to this horrible disease. While AIDS causes about the same number of deaths in the U.S. as prostate and breast cancer, AIDS research receives four times the funding of breast cancer, more than 20 times the funds of prostate cancer, and almost 50 times the spending per death as heart-disease research.
There are good reasons to give liberal financial support to AIDS research. Victims of the disease are typically young. Researchers are making dramatic treatment gains. And the disease is new, still spreading, and on an unpredictable path--although the odds of infection from drug use and sexual intercourse can be greatly reduced through clean needles and condoms. Nevertheless, the political effectiveness of AIDS activists surely helps explain why a much larger chunk of the federal budget is allocated to AIDS research than to other terrible and painful ailments.
Government spending on diseases probably should be increased from its modest present amount, since potential benefits from fundamental medical discoveries are so large. But even current spending levels would be much more effective in promoting medical progress and saving lives if political considerations did not exert such a large influence over the allocations of funds among different diseases.BY GARY S. BECKER