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Washington Update
President Bush's proposed FY 2003 budget is evoking both praise and criticism from those concerned about national health.
One provision is a record $3.7 billion funding increase for the NIH, which completes a five-year program, begun in 1998, to double the agency's budget. This includes a 500 percent increase in bioterrorism research funding, which would go primarily to the National Institute of Allergy and Infectious Diseases, and a $600 million increase in funding for cancer-related research, to be allocated among 27 NIH institutes and centers, including the NCI. Critics fear that the disproportionate increases in only two areas will jeopardize research progress against AIDS, diabetes, malaria and other diseases.
The budget proposal also contains a $94 million cut in funding for the key federal agencies that fund health services research. The Agency for Health Care Research and Quality (AHRQ) would lose $28.4 million, and the CDC would see the elimination of its entire budget of $17.5 million for extramural prevention research.
Another proposed FY 2003 budget provision is one that President Bush hopes will reduce illegal drug use in the United States by 25 percent over the next five years. Federal funding for drug treatment and research would increase by six percent to $3.8 billion, with $644 million allocated for federal programs to promote drug-free schools and communities, and $180 million earmarked for advertisements informing youths about the dangers of drug use. While some applaud this increase, others note that the amount allocated for treatment, research, and prevention -- which is only one-seventh the amount allocated for law enforcement -- is still too small to achieve the president's stated goals. Mike Brady, a public policy consultant for the California Senate, suggested taking all planned anti-drug funding increases and channeling them into treatment. Treatment costs about $3,000 to $6,000 per year, he noted, while one year of offender incarceration costs at least $25,000 (LA Times,
2/13/02).
Top federal health officials continue to vacate their posts, with no certain replacements in sight. Dr. Jeffrey Koplan made a surprise announcement that he will resign as director of the CDC effective March 31. Surgeon General David Satcher vacated his office on Feb. 13. Before leaving, Satcher expressed his belief that the surgeon general should communicate directly with the public to provide the best available public health science, without regard to personal opinion, politics or White House support. In that respect, Satcher noted, "The surgeon general has to be prepared to be beat up from the podium of the White House." At the same time, Satcher explained that he opted to lie low during the anthrax scare because he considered it his responsibility to communicate established scientific information, which was lacking at the time. Once public confusion and concern became obvious, however, he felt it was time for the American people to hear from him -- even if all he had to say was "we're all learning together" (Associated Press, 2/10/02). Although Satcher's replacement has not been named, Dr. Kenneth Cooper is reported to be the White House's top candidate.
Meanwhile, potential candidates for other vacant offices continue to come and go. Alastair Wood is no longer under consideration for the head position at FDA, because of dissent from the pharmaceutical industry, according to some reports. Another published report quoted an unidentified official in the Bush administration as saying that Anthony Fauci, M.D., is no longer under consideration for the directorship of the NIH. Apparently, Fauci's desire to continue research at the National Institute of Allergy and Infectious Diseases isn't the only problem; his silence on whether he supports abortion rights also raises concerns among members of the Bush administration. The New York Times reported on Feb. 23 that the White House is now considering Dr. Elias Zerhouni, executive vice dean and chair of radiology at Johns Hopkins University School of Medicine, for the top NIH post.
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