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US legislators would keep NIH flat-funded in 2013

A key figure bearing on the fiscal fate of the US National Institutes of Health (NIH) was published today: the US House of Representatives subcommittee that funds the agency proposed sustaining it with a flat, US$30.6 billion budget in 2013 — the same figure that President Barack Obama requested in February. Because the NIH-funding committee in the Senate has already called for a $100-million boost for the biomedical agency next year, the agency looks likely, in a financially precarious time, to have escaped the absolute cuts of the budget axe, at least for the moment.

However, says Darrell Kirch, the president and chief executive of the Association of American Medical Colleges: “The bill’s rigid requirements for the National Institutes of Health research-grant awards process, coupled with a freeze of that agency’s budget, would undermine NIH’s ability to support the most promising, scientifically driven research proposals at medical schools and teaching hospitals nationwide.”

In a departure from typical funding bills, the proposed law stipulates that the NIH  “maintain an allocation of 90% to extramural activities, 10% for intramural activities, and at least 55% toward basic science activities.”  It is also required to fund a precise number — 16,670 — of training awards and fellowships for undergraduates, doctoral students and postdoctoral researchers.

A summary of key figures in the House subcommittee bill is available here, and the full bill can be perused here.

In the bill, which funds the labor, health and human services (HHS) and education departments and related agencies in 2013, the Republican-controlled subcommittee zeroes out the $405-million Agency for Health Care Research and Quality, which they see as Trojan horse for health-care rationing. The bill declares it “terminated” effective 1 October 2012.

“We cannot afford to zero out funding for the Agency for Healthcare Research and Quality (AHRQ) at a time when it is addressing medical errors that kill more than 100,000 people a year and accelerating patient access to the best medical practices,” Mary Woolley, the president and chief executive of the advocacy group Research!America complained in a statement.

The House subcommittee is kinder to the NIH’s controversial National Children’s Study, which both the Obama administration and the Senate had sought to cut by $28 million, to $165 million, in 2013. The House bill funds at $175 million the ambitious study of influences on the health of 100,000 children from before birth to age 21. However, it also stipulates that controversial changes proposed for the study may not be implemented until 90 days after an Institute of Medicine study reviews them and weighs in on their impact. (Such a study has not been commissioned by NIH.)

In a continuing tug-of-war over funding for the Institutional Development Awards programme (IDEA), which builds biomedical infrastructure in rural states, the House subcommittee offers IDEA funding of $376 million — fully $100 million more than its Senate counterpart has proferred, and $150 million more than the Obama administration requested.  Where is it coming from in a flat budget? More than $84 million of the new money for IDEA is taken out of the office of NIH director Francis Collins. Collins and his staff are also forbidden from travelling until they implement a pilot programme Congress requested last year, asking third-party insurers to pay for patients on clinical trial protocols at the NIH’s Clinical Center.

The House subcommittee would fund the NIH’s new National Center for Advancing Translational Sciences (NCATS) at a flat budget of $575 million, short of the $639 million requested by the Obama administration and offered by the Senate. Within NCATS, the House would offer the Cures Acceleration Network — an unconventional effort to speed “high needs” drugs to patients — just $10 million, instead of the $40 million proposed by Senate funders or the $50 million requested by Obama.

The House bill is an incremental step in a long journey to final funding figures for HHS agencies. Many expect that they will not be pinned down until after November’s presidential election.

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