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Cancer Research Advocates Must Be Vocal to Reverse Funding Trends
By Greg Brozeit

With public attention focused away from domestic concerns over most of the past two years, congressional and administration attention to medical research funding—and funding for cancer research in particular—has been overshadowed.

This year the One Voice Against Cancer (OVAC) coalition is requesting a funding increase of 8.5% for the National Institutes of Health (NIH) and fulfillment of the FY 2004 National Cancer Institute (NCI) Director's Bypass Budget at $5.9 billion.

A letter addressed to the respective chairs of the Appropriations Subcommittees on Labor, Health and Human Services, and Education encouraging them to make cancer research funding a top priority has been signed by 61 members of the House and 27 members of the Senate. This occurred in large part because of the advocacy of the attendees of the OVAC advocacy day in early April. But your continuous advocacy is needed to make them mean it.

Fulfilling the Bypass Budget is unlikely this year, but closing the gap between it and the final approval of congressional funding for NCI is the best hope for increasing myeloma research. Unfortunately, that gap is increasing and will continue to increase if advocates do not remain consistently vocal to make cancer research top national priority.

The gap between the current funding level for NCI and the FY 2004 Bypass Budget is more than $1.2 billion. This money could be spent effectively right now, especially considering the fact that NCI funds only 28% of their approved, peer-reviewed research grant proposals.

Although Congress fulfilled the five-year pledge to double funding for NIH and OVAC received a great deal of credit from leaders in Congress in maintaining the funding level of $27.2 billion, the details were somewhat devilish for cancer advocates.

A loyal IMFer rightly called me to task a month and a half ago for not acknowledging some of those details and the implications they held for all cancer patients and advocates. The consequences began with the passage of the omnibus appropriations bill earlier this year.

All I can say in response is mea culpa. And I need to explain.

The Post-September 11 Impact on Cancer Research

Let's start with President Bush's FY 2003 budget proposal that recommended $4.7 billion for the National Cancer Institute (NCI). The final figure approved by Congress and signed into law was $4.6 billion, representing an increase of $400 million over the previous year. Sounds acceptable.

Reversing a trend, however, this was the first time in memory that Congress approved a lower funding level for NCI than was recommended by the president's budget. This includes the first Bush administration, the Clinton administration, and the first years of the second Bush administration.

But while the overall funding for NIH increased by almost 17%, the NCI increase represented an increase of just more than 8%. More importantly, it was more than $1 billion below the amount recommended in the NCI Director's FY 2003 Bypass Budget. The Bypass Budget, as loyal readers of the Myeloma Minute well know, is the professional judgment budget that the NCI Director is required by law to submit to the president and Congress. The gap between that budget and the amount NCI actually receives continues to grow.

Why the discrepancy between the increase in NIH and NCI funding? Because hidden in the overall funding for NIH was the fact that the lion's share of institute-specific increases went to bioterrorism-related functions.

So while Congress technically fulfilled its promise to double the NIH budget over five years, it did so by increasing funds for the newly created post-September 11 bioterrorism priorities and at the expense of other medical research. Remember that the emphasis on bioterrorism did not exist when the doubling pledge was made more than five years ago.

It can rightfully be argued, therefore, that Congress did not fulfill its intent to double NIH funding when looking solely at the priorities that were laid out five years ago.

Recently, during a visit I had with an administration official, it was mentioned that when those airplanes hit the Twin Towers, it signaled an end to the relatively strong increases for medical research to which we have become accustomed. Those strong increases gave research advocates reason for optimism.

The first indication of the change came when President Bush unveiled his FY 2004 budget earlier this year. In sharp reversal of the administration's support for medical research in the previous year, it requested only a 2% increase for NIH, which equals the relative rate of inflation. In other words, it was no substantive increase at all. Since then, the request made to Congress has been increased to an additional $2.7 billion.

The numbers for NCI are more disheartening. In the president's budget, the recommendation for NCI was $4.77 billion, an increase of $170 million over the current amount. Interestingly, it is only $70 million more than the administration requested in last year's budget.

Going back to the NIH recommendation however, it is important to remember, according to NIH Director Elias Zerhouni, that the NIH research budget will increase by 7.5%. According to a recent analysis of the Friends of Cancer Research, however, "after excluding increases for homeland defense, he noted that the research components of the NIH budget will only truly increase by 4.3%." And the cancer increases will be lower still.

Advocacy Matters

It is possible to reverse this trend. With an estimated federal budget of $2.2 trillion, we must not be apologetic about demanding an additional $1.2 billion to fulfill the NCI Director's Bypass Budget.

Our nation's investment in research since President Nixon's declared War on Cancer more than thirty years ago is now reaping amazing rewards and promise.

We are on the verge of unprecedented, historic achievements in cancer research. NCI Director Andrew von Eschenbach's initiative to eliminate suffering and death due to cancer by the year 2015 is not a pipe dream. The promise of genomic and proteomic research make it possible, if not probable.

But "we will only win the War on Cancer if," as President Bush said two years ago in a speech at the White House, "we fund the War on Cancer."

And we will only fund the War on Cancer if advocates like you make it clear to your members of Congress that cancer research must remain a top priority of our government. It must be as important as the war on terrorism. In fact, as IMF President Susie Novis has stated for years, living with myeloma is like living with a terrorist. Just as we must fight external terrorism, we must fight the internal terrorism of cancer.

Too much of the political debate not related to the war this year has been focused on tax cuts. The implementation of large tax cuts will necessarily impact other budget concerns including medical research funding.

The impact will be even more negative if advocates do not impress upon their representatives and senators that cancer research must remain a top national priority—as important as national security, the fight against terrorism, and tax cuts. The media will not make the case for us. It will take hard, consistent effort from every individual who believes that cancer research is worth paying for.

First, however, you must make the commitment that cancer research is worth fighting for.

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