Clinton Goes Slow on Health Research


August 10, 1993|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- A dispiriting nonchalance has so far characterized the Clinton administration's approach to health research and the government organization mainly responsible for its direction and finance, the National Institutes of Health (NIH).

Money and people are the measure of interest in these matters. On both counts, the White House has so far been deficient, proposing spending cuts in some crucial fields of health research and only just now naming a replacement for the Bush-appointed director who left NIH at the end of June.

The choice is commendable: Harold Varmus, a Nobel laureate from the University of California. But his selection came too late for a pre-vacation confirmation hearing in the Senate. Mid-September is the earliest that he may take the oath of office.

It will be argued, of course, that the economy, the Balkans and a testy Congress have naturally pre-empted the attention of the administration. Medical research and discovery tend to move glacially, even in the best of circumstances, with scant response to political timetables. So, why should the White House hurry to focus on the fiscal and policy obscurities of the health sciences?

The answer is that NIH, renowned as the world's greatest and most bountifully financed health-research organization, has been either drifting or in administrative turmoil for the past four years. Its budget has plateaued at about $10 billion in recent years.

Though immense by standards of any nation, the sum is woefully short to finance the bulk of bright research possibilities in health science. Two out of three research applications deemed worthy of support are routinely rejected for lack of money.

The directorship was filled on an acting basis for 20 months at the outset of the Bush administration because of pro-lifers' insistence on a so-called abortion litmus test for candidates.

When none of the scientists sought by the Bush White House would comply, the test was quietly scrapped and NIH acquired its first woman chief, Bernadine Healy, a cardiologist and research director from the Cleveland Clinic.

Dr. Healy brought an impressive resume and many talents to the job. But with a managerial style reminiscent of Gen. George Patton, she soon was at odds with Congress, her departmental superiors and the collegial style that has generally marked NIH procedures.

Her efforts to prepare a long-term strategic plan for NIH were stymied by her political overseers, who suspiciously regarded the exercise as a budget-busting ploy. Her proposed personnel appointments at NIH were ignored for months by the powers with approval authority.

Meanwhile, as AIDS research came to occupy a larger portion of the government's health-research spending, the beleaguered NIH lacked the political clout to sustain even modest growth for research on other health problems.

The budget that Clinton proposed to Congress last spring aggravated the problems of health-research funding by holding the total for NIH steady while increasing the share for AIDS and breast cancer research. Both can make good use of additional funds, but then so can research on cancer, heart disease, Alzheimer's and so on.

Dr. Healy complied with the Clinton administration's request for her to stay on at least temporarily, and then was totally ignored by the White House and excluded from policy and budget deliberations.

The great health-care reform planning exercise led by Hillary Rodham Clinton paid virtually no attention to health research, a key factor in rising health care costs. Dr. Healy, the chief of the great NIH, was not consulted.

At the end of February, Dr. Healy was told that she would not retain the post. Recalling the long hiatus preceding her own appointment, Dr. Healy said she hoped a successor would be promptly appointed to avoid another leaderless gap but that, in any case, she would depart by June 30.

That date came and went without a successor. At this point, NIH is led by an acting director, an arrangement that satisfies legal requirements but lacks authority for fighting in Congress and elsewhere for the needs of medical sciences.

The care and feeding of health research should not rank at the top of the presidential agenda. But the issues involved certainly deserve better than Bill Clinton has given them.

His attention might be drawn by the fact that health research always comes out high when pollsters ask where the government should spend more money.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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