A Reason for Hope

No other federal agency has the breadth of political and public support of the National Institutes of Health. Even still, most years are a struggle for NIH funding. Despite all the goodwill, the agency is caught in the same downward pressure on federal spending as the rest of the U.S. government. In the largely zero-sum game of the federal budget, an extraordinary raise for the NIH (as opposed to a small raise) moves ahead only by cutting other programs. Or, this year, apparently by some windfall savings from the Pell grant program (and maybe some from children’s health programs?).It is a testament to the intense and successful lobbying of NIH advocates that: (a) the money was found, and (b) it was applied to NIH and not split among dozens of other labor and human resources programs.CDC and AHRQ weren’t as fortunate and would suffer cuts under the Senate bill. As Research!America has stated: “underinvesting in CDC and AHRQ is a costly mistake.” The inevitable conclusion is that public health, as a cause (as opposed to biomedical research, as a cause), still has a ways to go before it captures the imagination of policymakers the way NIH does.Typically, we don’t talk about the Labor-HHS appropriations bill, but this week’s mark-up highlights several themes important to FDA stakeholders.First, we have always maintained that a strong NIH is good for FDA (and the reverse also, a strong FDA is good for NIH). Increased public commitment to NIH -- while no substitute for dollars to FDA -- nonetheless has tangible benefits for the agency. Next step is to be held in the same regard as NIH -- bipartisan and bicameral, as well as strong Administration support. We are not there yet.Second, the comparatively lower regard for public health infrastructure and programs has consequences for the FDA. Whether we consider food safety modernization, medical product approvals, or any of a dozen other key FDA missions, the agency is foremost a public health regulatory agency. We are in a different appropriations bill than other public health programs, but the impact is only somewhat different. Public health is not the priority it needs to be and FDA suffers.Based on the Senate and House committee mark-ups, FDA is slated for a 1% to 1.5% increase. More is still possible. The reason for hope is that our appropriators understand the importance of FDA and the pressures it faces. They also are aware how the Administration’s low-ball request has hamstrung efforts to fund FDA properly. If there were more money available, I believe some would find its way to FDA. That would be a victory for public health, as well as the FDA.Note: This week’s Analysis and Commentary was written by Steven Grossman, the deputy executive director of the Alliance for a Stronger FDA.