Map of life expectancy at birth from Global Education Project.

Tuesday, January 26, 2010

I had a good excuse

for not posting yesterday -- an NIH proposal deadline. There is an ineluctable law of nature, that no proposal is ever finished before the deadline. I thought I had violated it by three hours, but then a glitch happened and the actual time stamp on my submission turned out to be 16:50, which is ten minutes before the deadline.

Anyhow, this seems a good occasion to give a quick tour of the National Institutes of Health extramural research funding process. It's your money, after all. Federal funding for health-related research is pretty popular, but there is something of a perverse influence in that it is built largely around constituencies for specific diseases. People advocate for cancer, HIV, diabetes, heart disease, MS, etc., and to a considerable extent the allocation of funds is influenced by the strength of the various disease lobbies. NIH is divided into numerous institutes and centers. Some are defined by organ systems or categories of disease. Examples are the National Cancer Institute, National Heart, Lung and Blood Institute, National Institute on Drug Abuse, etc. (Alcoholism has a separate institute, which makes absolutely no sense scientifically but does reflect deeply rooted cultural biases.) Note that some of these have narrower definitions than others; some of them are sort of a grab bag, such as the National Institute of Diabetes and Digestive and Kidney Diseases. Then there are life-cycle institutes -- National Institute on Aging, National Institute of Child Health and Human Development; and more etiologically or contextually defined institutes -- National Institute of Environmental health Sciences, National Center for Minority Health and Health Disparities; and finally the discipline-focused institutes such as the National Center for Nursing Research and the much-maligned National Center for Complementary and Alternative Medicine. The National Institute of General Medical Sciences supports basic research that doesn't need a specific disease or other kind of focus.

So you'll see right away that the organization of NIH reflects multiple theoretical orientations toward health and illness, and multiple political dimensions of interest. The process for allocating funds to particular areas of research starts with some political guidance from Congress but the process of awarding funds to specific investigators for specific studies is purportedly designed to be insulated from politics and based on science. Next time, I'll give you my own take on that. (I'll also tell you something about my own proposal.)

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