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BMJ. Jun 26, 1999; 318(7200): 1715.
PMCID: PMC1116068

US research funding depends on lobbying, not need

The first systematic comparison of the US National Institutes of Health spending on research shows that some diseases backed by strong political lobbies, particularly AIDS and breast cancer, may be receiving a disproportionately large share of federal research money in relation to their toll on public health.

Researchers compared levels of funding for 29 diseases as predicted by total health burden with the actual funds allocated in 1996 by the National Institutes of Health. They found that four diseases with strong political lobbies—AIDS, breast cancer, diabetes mellitus, and dementia—received more money according to a composite measure of disease burden than diseases with less vocal advocates (New England Journal of Medicine 1999;340:1881-7).

The researchers used disability adjusted life years (DALYs) to express the global burden of a disease. One DALY is defined as one year of healthy life that has been lost because of disability or death. The study’s lead author, Cary Gross, a Robert Wood Johnson clinical scholar at the Johns Hopkins School of Medicine in Baltimore, said that he was interested in DALYs because previous funding relationships had shown that both death and disability had an impact on how research money was allocated.

AIDS received $1.4bn (£8.7m) in grant money, with the disease estimated to lead to the loss of 1.27 million DALYs, a breakdown of about $1114 per DALY. Breast cancer received $381.9m for 1.42 million DALYs, or $269 per DALY. By comparison, depression, stroke, perinatal conditions, and emphysema were judged to be underfunded ($17 to $27 per DALY).

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