BETHESDA -- The National Institutes of Health used to feel like a bucolic college campus. Now it is a giant construction project, with cranes and bulldozers erecting new laboratories, a new research hospital and a new center for vaccine research.
The activity here is the tangible symbol of a huge new federal investment in biomedical research. Congress is providing far more money than President Clinton requested because congressional leaders of both parties have vowed to double the agency's budget over five years -- a process that began with the 1999 appropriations bill, which just became law.
The institutes have always enjoyed respect on Capitol Hill. But lawmakers said they had increased the agency's budget more than usual because they believed that researchers were on the threshold of a new era. Discoveries in many fields -- especially genetics, neuroscience and cell biology -- promise to save lives and transform the practice of medicine in the next decade, they said.
Congress provided $15.6 billion for the 1999 fiscal year, which began on Oct. 1, up from $13.6 billion in the prior year -- an increase of $2 billion, or 15 percent. That rate of increase, sustained and compounded over five years, would double the institutes' budget by the year 2003.
The 322-acre campus of the institutes is a beehive of activity as construction crews reroute traffic, tear down trees, build new roads and excavate a maze of tunnels to deliver steam, water and electricity to the buildings.
But scientists here receive just 10 percent of the agency's budget. The rest is distributed to universities, medical schools, teaching hospitals and private nonprofit research institutes. Most of the money goes for basic research, to investigate fundamental properties of genes and cells, or to test new methods of treating diseases and disabling conditions. Among the priorities recommended by Congress are mapping the human genome, preventing Alzheimer's disease and finding better ways to detect ovarian cancer.
Congress also provided $30 million this year for renovation and construction of biomedical research laboratories around the country. Sen. Tom Harkin of Iowa, the ranking Democrat on the Appropriations subcommittee responsible for the National Institutes of Health, said he would seek much bigger increases for such construction spending in the next couple of years. He is likely to find allies among Republicans, including Sen. Arlen Specter of Pennsylvania, chairman of that subcommittee.
"The $2 billion increase for NIH is simply breathtaking," said Donna Shalala, secretary of health and human services. "It's extraordinary, the single largest dollar increase in NIH history."
In his budget request in February, Clinton sought a more modest increase, $1.14 billion, or 8.4 percent, which would have been financed through an increase in tobacco taxes. But Congress never approved the tobacco proposals.
A congressional aide who works on the institutes' budget said the big increase this year resulted mainly from lobbying by public health groups and advocates concerned about specific diseases such as breast cancer, AIDS, diabetes and Alzheimer's. These groups work closely with scientists and medical schools in lobbying Congress.
"NIH stood on the sidelines," said the congressional aide, who spoke on the condition of anonymity. "NIH didn't lobby hard for this."
In a recent interview, Dr. Harold Varmus, director of the National Institutes of Health, said: "I'm a team player. We are part of the administration, and we supported the president's budget request. We don't have to advocate. We have advocates, very strong advocates, in the disease groups and professional organizations."
In the last two years, the institutes' budget grew an average of 7 percent a year, which enabled the agency to prepare for the construction now under way.
Clinton is directly responsible for one project, the five-story vaccine research center, being built at a cost of $29 million. In a speech at Morgan State University in Baltimore in May 1997, Clinton declared a national goal of developing an AIDS vaccine within 10 years. Much of the work to achieve that goal will take place at the center. Researchers there will also work on vaccines for other diseases such as malaria and tuberculosis.
Varmus, who won a Nobel Prize in 1989 for his research on cancer-causing genes, said he was pleased that Congress had generally resisted the temptation to earmark money for specific research projects at specific universities.
The windfall comes just as the agency is trying to give patients and ordinary citizens a bigger voice in setting research priorities. The National Academy of Sciences gently chided the agency this summer, saying it had not sought enough public comment on these important decisions. Varmus said he was searching for ways to "enhance public participation in NIH activities," as the academy recommended.
While Congress did not dictate precisely how money should be spent in the new appropriations law, it did offer advice in a report that accompanied the legislation. Over the years, officials of the institutes have won the trust of lawmakers by closely following such recommendations whenever they could.
This year, for example, Congress urged the institutes to support more research on progressive supranuclear palsy, a disabling condition similar to Parkinson's disease; Behcet's syndrome, a rare chronic inflammatory disorder, and brittle bone disease, an inherited condition that leaves people susceptible to fractures throughout their lives.
Pub Date: 11/08/98