1348 NATURE MEDICINE • VOLUME 4 • NUMBER 12 • DECEMBER 1998

NEWS

The US Congress has approved thelargest ever increase in funding for theNational Institutes of Health (NIH)—awhopping 15 percent raise that takes theFY99 budget to $15.6 billion. Theincrease means that the NIH is on trackto double its budget by 2003. NIH Direc-tor Harold Varmus says that the addi-tional $2 billion will mean “more ofeverything: more grants, and a lot of newinitiatives.” In particular, the increasewill mean more research into prostatecancer and alternative medicine.

It is widely recognized that persistentand aggressive lobbying to increase sup-port for biomedical research was respon-sible for the substantial increase. “Wehave very strong advocacy on our behalffrom a wide number of constituents,”Varmus told Nature Medicine. He said thathe also appreciated that Congress largelyresisted its usual urge to earmark moneyfor specific studies and designated acade-mic centers. “Having the budget carvedup like that is a very bad thing to do,” saidVarmus, and added, “but we always listento their guidance.” Such guidance thisyear included several strong recommen-dations.

The first was that NIH make prostatecancer research a high priority. The FY99Omnibus Appropriations bill states that“spending for prostate cancer researchover the years has not kept sufficient pacewith the scientific opportunities and theproportion of the male population whoare afflicted with this disease,” and callsfor accelerated spending in this field.Within the next six months, the NIHmust present a report to Congress outlin-ing plans for prostate cancer research overthe next five years.

Another recommendation was that theinstitutes develop a full-scale initiative tofind ways to prevent Alzheimer disease inthose who may have a familial predispo-sition to it.

While Congress “urged” NIH to act onthese and other recommendations it didtake one, more specific, action: to elevatethe small Office of Alternative Medicine(OAM) to a Center—a move typicallyregarded as one step before becoming anInstitute. In addition to its heightened sta-tus, the OAM will receive a $50 millionbudget, more than doubling its existingfunds of $20 million, and an astronomicalrise since its inaugural FY92 appropriationof $2 million. Of the new budget, not lessthan $20 million must be spent on peer-

reviewed research grants.Tom Harkin (Dem., Iowa) a well-

known believer in alternative medicine,who was responsible for establishingthe OAM through a congressionalmandate in 1991, was also behindthe FY99 OAM changes. And as ifto reinforce the virtual re-birthof alternative medicine withinNIH, it must change its name tothe National Center for Com-plementary and AlternativeMedicine (NCCAM). Incum-bent director Wayne Jonaswill leave the center at theend of this month to returnto the army having completed his three-year military detail, and his replacementis expected to be announced on January1st 1999.

In fact, NCCAM is a shining exampleof how acutely tuned Congress is to themood of the public when making spend-ing decisions. According to a study pub-lished last month (JAMA 280, 1569;1998), four out of 10 Americans usedalternative medicine therapies in 1997and visits to alternative medicine practi-tioners have increased by 50 percentfrom 1990, now exceeding visits to allprimary care physicians. Moreover,Americans spend around $21.2 billion onservices provided by alternative practi-tioners.

Despite the presence of alternativemedicine within the Office of the Direc-tor on the Bethesda campus, manybelieve that Varmus and other NIH offi-cials merely tolerate work in this area and

are reluctant to embrace it alongside tra-ditional biomedical research. But Varmusdispelled such rumors. “Two years ago I’d

have been unhappy about this [man-date], but now we’re ready for it,”Varmus said. “We know what needs

to be done in the area of highquality research. We are set-ting up this new center, andwe’re recruiting a new direc-

tor. We want to get someoneopen-minded, but also a

skilled clinical trialist whounderstands how you testtherapies.”

All of the NIH instituteswill share the $2 million bounty. Eachgets a minimum 10 percent raise, but thebiggest institutes come out ahead: theseinclude the National Cancer Institute (15percent increase); the National HumanGenome Research Institute (22); and theNational Institute of Allergy and Infec-tious Diseases (16).

NIAID director, Anthony Fauci, saidthat his institute would focus moreresources on the problems of emergingmicrobes, tuberculosis and malaria. It alsoplans to draft a major initiative onimmunological tolerance, with specificapplications to organ transplantation.Other areas include autoimmune diseases,HIV vaccine development, and protectionagainst bio-terrorism.

“It’s hard to start a lot of programs inone year, but I think we can do it,” saidVarmus.

KAREN BIRMINGHAM, NEW YORK & MARLENE CIMONS, WASHINGTON, D.C.

Alternative medicine and prostate cancer benefit from largest ever NIH increase

German coalition overlooks biomedical scienceA “doubling of investments in the fu-ture” was one of many promises made byGermany’s Social Democratic Party (SDP)before their landslide victory in theOctober election. Yet four weeks later,neither public health nor R&D wereamong the top priorities in the coalitiontreaty signed by Helmut Kohl’s successorGerhard Schroeder. Pre-election pledgesof doubled investment have withered to“clear increases.”

The treaty, intended to serve asGermany’s political road map into thenext millennium, focuses naturally onthe most serious problem that faces thecountry—unemployment. But although“sustainable economic growth by inno-vation” is a phrase used throughout the

document, nowhere is it linked to R&D,a coupling that governments of other de-veloped nations see as a route to eco-nomic prosperity. The treaty makes nomention of financial commitments tothe Ministry of Science and Educationheaded by Edelgard Bulmahn (SDP) or tothe Ministry of Health under the direc-tion of Andrea Fischer (Green Party).

Nevertheless, optimism prevails atGermany’s basic research grant agency,the Deutsche Forschungsgemeinschaft(DFG). Bulmahn has served as chair forthe parliament’s Science committee inrecent years, and is seen as “competentand knowledgeable,” according to DFG-spokeswomen Eva Streier.

On Bulmahn’s appointment, the head

Sheila Foran

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