Each year a new national budget for discretionary spending is proposed, edited, accepted, and then used to divide up federal funds. Currently, the 2018 budget has been proposed and is undergoing edits. For reference, I’ll use the 2017 budget.1
Part of this discretionary spending goes to science and technology research, or Federal R&D. It’s important to recognize that R&D isn’t localized to just one department, but rather is spread over several, such as the NIH (National Institute of Health), the USDA (US Department of Agriculture), the DOD (Department of Defense), and etc. Within the budget proposal will be a proposal of how much of the total R&D budget should go to each department. Once this is edited and approved, each department uses its own boards and councils to decide what research is funded through grants given by the department. Typically a research PI (primary investigator), such as a professor with a research laboratory at a university, will write a grant proposal. This will explain the significance of the research they are proposing, and how money from any grant obtained will be used.
From the graphic to the right, it’s clear that the allocations are not equal.2
Even within the department’s own spending, there is priority funding for some subjects over others. For example, the NIH devoted $168 million to pancreatic cancer research in 2016.3 In that same year, the NIH devoted $274 million to colo-rectal cancer research. For context, the prevalence of pancreatic cancer among is 0.1%, while colo-rectal cancer has a prevalence of 0.6%. We must also compare the prognosis of each cancer type. Even with early detection, a person with pancreatic cancer has a poor prognosis. The five-year survival rate is only 7%, including all stages of detection.4 With early detection at Stage I, there is a 5-year survival rate for colon cancer of 92%.5 Even in late-stage detection, the 5-year survival rate is 11%. There is also the chance of detection to be considered. Colonoscopies are a part of regular checkups for most upon reaching age 50. However, pancreatic cancer screening is non-routine, and as demonstrated, is not likely to improve the chance of survival. Thus far there is no widely-effective treatment for pancreatic cancer, while colon cancer, on a wide-scale, can be detected early and more-often-than-not treated effectively. So why do we fund more colo-rectal cancer research than pancreatic cancer research? Is it because colo-rectal cancer has a prevalence of 0.5% more than pancreatic cancer? It comes into question how priorities are set, and whether funding priorities are the most effective means of allocation research dollars.
In another vein, allocation of federal funds to different departments often has to do much with contextual politics. For example, a president who has promised to decrease defense spending, if they intend to keep their promise, might propose lower R&D allocations to the DOD. A current example is President Trump’s proposed 2018 budget. Historically, the Republican party has been critical of climate change science, as has the President himself. We can see this come into effect in his proposed budget with cuts to both the EPA (Environmental Protection Agency) and DOE (Department of Energy). Overall, the EPA has a proposed cu of 31%, and the DOE a proposed cut of 5.6%.6 Cutting the EPA by this amount will lead to less money the department itself will be able to allocate toward clean energy research, including a 60 million dollar cut to Air and Energy research, set up in the EPA’s own proposed budget.7 Even though a 5.6% cut to the DOE seems minor, most of the cuts will be in its own clean energy research. Clean energy research has often been justified because of climate change science, so it makes sense, knowing the Republican party and President Trump’s own disbelief in climate science, that the President’s budget wouldn’t allocate a large amount of funds to CER. It also must be recognized that each of these department heads is nominated by the president, so often it is politically wise for a president to nominate a person whose interest align with their own. This allows the president to have some influence over departmental priorities, and thus their budgets.
However, it must also be understood that these priorities have often been set for non-political reasons, but rather logical ones. If one disease is much more prevalent in a nation’s people than another, or has more effect on the population, it is reasonable to have more research funded to understand and either treat or cure that disease. The question is how these priorities should be made. In the case of cancer funding, should the most prevalent cancer be the research that has priority funding? Or should it be the least effectively treated? Or the one that is actually killing the most Americans? It could also be heavily dependent on what research grant proposals have been submitted, and the potential of each. It could be that there are more colo-rectal cancer research proposals worthy of research investment than studies of pancreatic cancer. Funding priority isn’t easily justified, and it seems unreasonable for it to be fully explained until you ask someone who’s loved one died of pancreatic cancer. It’s also not easy to justify prioritizing pancreatic cancer research if colo-rectal treatment could be effectively improved, using research, to effectively better a patient’s quality of life. It’s not easy to prioritize funding research of one disease over another, and there are no clear answers. When dividing federal funds between the departments, is it enough to have a President’s team making priorities? After all, the President should have been the majority choice of the people. Therefore they should have known what his priorities were before voting for the person, and should agree with a budget that sticks close to campaign promises. While the original allocations may be political and perhaps representative of how a nation voted, some allocations aren’t as clearly representative of the people’s choices. The cancer research priority funding is an example of this. None of the presidential candidates likely mentioned increasing the budget for pancreatic cancer research. This kind of priority funding isn’t part of a candidate’s campaign, so it can’t be said that the people directly chose it. It could be argued, however, that the people voted in a president who then chose a department head. That department head oversees priority funding, and thus the people did indeed, very indirectly, have an effect on funding priorities.
When prioritizing research, the NIH seeks out advice from several sources, including NIH staff, the scientific community, Congress, and others. While much of the budget is public, I couldn’t find written justifications of how individual disease research funding was allocated. This could be because I didn’t dig enough, though, or didn’t know where to look. It would be interesting to know how value is place on research of each disease. I’ve sent this email to the NIH Contact Us link:
Hi, I was looking at the NIH Categorical Spending, and I was wondering how research funding is prioritized between diseases. Is it based on a variety of factors that are taken into some lump value? For example, I was wondering why colo-rectal cancer research has more funding than pancreatic cancer research. I understand that colo-rectal cancer is more prevalent, but there also seem to be better survival rates for colo-rectal and more effective treatments already available, while pancreatic cancer survival rates are very low and there is no widely effective treatment. If it is based on a variety of factors, is there some common guide to evaluate these factors together, and if so, does the public have access to this? Thanks for any help in answering my curiosity.
I’ll update this blog if and when I receive a reply. Hopefully, someone within these agencies can provide this information.
- Tucker, J. The President’s 2017 Budget Proposal in Pictures. National Priorities Project. Published 17 February 2016. Accessed 26 July 2017. https://www.nationalpriorities.org/analysis/2016/presidents-2017-budget-in-pictures/
- Historical Trends in Federal R&D. AAAS. Updated June 2016. Accessed 26 July 2017. https://www.aaas.org/page/historical-trends-federal-rd
- Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC). NIH. Published 3 July 2017. Accessed 26 July 2017. https://report.nih.gov/categorical_spending.aspx
- Hirshberg Foundation for Pancreatic Cancer Research. Accessed 26 July 2017. http://pancreatic.org/pancreatic-cancer/about-the-pancreas/prognosis/
- What Are the Survival Rates for Colorectal Cancer, by Stage? American Cancer Society. Revised 2 March 2017. Accessed 26 July 2017.https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html
- Reardon, S.; Tollefson, J.; Witze, A.;Ross, E. US Science Agencies face deep cuts in Trump budget. Nature News. Updated and Corrected 16 March 2017. Accessed 27 July 2017. http://www.nature.com/news/us-science-agencies-face-deep-cuts-in-trump-budget-1.21652
- United States Environmental Protection Agency. FY 2018 EPA Budget in Brief. Published May 2017. Page 32. Accessed 26 July 2017. https://www.epa.gov/sites/production/files/2017-05/documents/fy-2018-budget-in-brief.pdf