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ADA Diabetes Advocacy update
May 14, 1998

Diabetes decision may come before July 4th

John Porter's committee in Congress is working on their annual spending bill. This bill will decide how much will be spent on diabetes research in 1999. Their plan is to have the bill written and approved before July 4.

So the next few weeks will be very important. It's our best chance to convince Congress to make finding a cure for diabetes a national priority. We have to keep up the pressure.

The government will spend $350 million on diabetes research in 1998. Compare that to $1.7 billion for AIDS, $2.9 billion for cancer and $1.1 billion for heart disease. ADA doesn't think funding for these diseases should be reduced. What we want is for the government to make a similar commitment to diabetes. Don't you?

ADA believes the government should spend $1 billion a year on diabetes research. To reach this goal, ADA has officially recommended that Congressman Porter and his committee agree to spend $545 million on diabetes research in 1999.

Spending $545 million in 1999 would put diabetes on track to reach a budget of $1 billion in just a few years. It would also show that Congress is serious about making a cure for diabetes a national priority.

So how did we come up with $545 million? Easy. Between 1987-97 diabetes research wasn't a priority to the government. That's when the government's medical research budget grew 100% while the diabetes research budget grew just 35%. Had diabetes research kept pace during this time, its budget would be $545 million in 1999.

This week, ADA sent a letter to Congressman Porter and his committee members. A copy was also sent to every member of the House of Representatives. (I have attached a copy of the letter to this email. I have also included the text of the letter at the end of this message.)

I urge you to read this letter. After reading it, you may want to contact your Congressman to make sure s/he received it. You may also want to let him/her know that you support ADA's recommendation of $545 million for diabetes research in 1999.

Thank you for your continued support of the ADA and diabetes advocacy. If you have any questions about the letter or anything else, please feel free to contact me.

Joe LaMountain
National Director of Advocacy
American Diabetes Association
1660 Duke Street
Alexandria, VA 22314
(f) 703-549-8748

Text of Letter to Congress
May 13, 1998

The Honorable John Edward Porter
U.S. House of Representatives
2373 Rayburn House Office Building
Washington, DC 20515

Dear Representative Porter:

On behalf of the 16 million Americans with diabetes, the American Diabetes Association strongly urges you to make finding a cure for diabetes a national priority as you consider appropriations for the National Institutes of Health (NIH) in the subcommittee on Labor, Health and Human Services and Education.

Diabetes, according to the Centers for Disease Control and Prevention (CDC), has become "the epidemic of our time." Diabetes prevalence has risen nearly 700 percent over the past 35 years. In 1997, diabetes resulted in $98 billion in direct medical costs and indirect expenditures, more than almost any other disease. It will kill more than 180,000 Americans in 1998.

Despite this burden, diabetes research has not been a priority to NIH. Between 1987-97,

1. Diabetes research funding grew 35% while the overall NIH budget increased 101%. As a result, diabetes researchers lost nearly $1 billion in NIH funding.

2. Diabetes research funding grew 35% while medical inflation (BRDPI) grew 48%. As a result, diabetes researchers lost $235 million in buying power to inflation. In real dollars, the government spent more on diabetes research in 1987 than it did in 1997.

3. The percentage of the NIH budget dedicated to diabetes decreased 33%. In 1987, NIH spent 3.9% of its budget on diabetes. By 1997, just 2.6% of the NIH budget was spent on diabetes research. By comparison, 27% of Medicare's budget ($28.6 billion) is spent treating people with diabetes each year.

Last year, in response to persistent questions regarding the allocation of its $13 billion annual budget, NIH released a report describing how it allocates funding for competing research initiatives. First, the report concluded, NIH must take the health needs of the nation into consideration. Second, NIH must take the scientific opportunities available in any given field into consideration.

Regarding NIH's first criteria, assessing the health care needs of our nation, diabetes imposes a burden unlike any other disease. It kills 180,000 people a year and is a leading cause of disability. It costs America $98 billion a year, more than almost any other disease; the federal government alone will spend approximately $27 billion treating Medicare patients with diabetes in 1998. The number of Americans diagnosed with diabetes has increased 700% since the 1950s; this will continue to increase as our population ages.

As for NIH's second criteria, assessing the scientific opportunities available in any given area, an NIH conference recently identified more than 50 areas of diabetes research that would benefit from greater investigation. NIH Director Harold Varmus himself stated recently that "we are at a time when the scientific opportunities*in diabetes have never been greater." He also stated that we are on "an important threshold for diabetes research."

It is abundantly clear that diabetes meets, if not exceeds, NIH's own published criteria for allocating resources. However, for some reason, the agency continues to significantly underfund diabetes research.

In recent years, Congress has frequently deferred to the recommendations of the NIH Director when making its decisions for funding medical research. Congress does, however, possess the authority and the responsibility to prioritize and set funding levels for competing NIH research initiatives. NIH Director Varmus acknowledged this fact at a March 26 hearing of the House Commerce Subcommittee on Health and Environment when he stated,

"Let me point out that money is not appropriated just to the NIH. I receive this money through 22 individual institutes and centers, each of which has some research focus. And Congress does exercise, at its discretion, manifestly and absolutely when it assigns different dollar values to each of those categorical institutes and centers. So there is some division of spoils right at the outset."

In light of NIH's decision to disregard its own criteria for allocating research dollars, it is not only appropriate, but necessary, for Congress to act. Based upon NIH's own priority-setting guidelines, Congress should significantly increase funding for diabetes research.

In the last two years, Congress and the administration have taken small steps to address the shortfalls diabetes researchers experienced between 1987-97. In FY 1998, the increase in funding for diabetes research was greater than that provided to NIH for the second time in 11 years. President Clinton's FY 1999 budget continues this trend by providing an 11% increase in funding for diabetes research while providing an 8% increase for NIH overall.

While appreciated, it is very clear that an incrementalist approach will not be successful in addressing the shortfalls of 1987-97. At the current rates of increase, it will take until FY 2010 for diabetes to catch up with overall NIH growth over the same time period. Clearly, without a major infusion of funding for diabetes research, the historic opportunities referred to by Dr. Varmus will be missed.

We believe that federal funding for diabetes research should be $1 billion in FY 1999. While not impossible, we recognize that it would be difficult to increase funding to $1 billion this year. But given current federal budget surpluses and the broad bipartisan support for diabetes and medical research in Congress, we believe that a budget of $1 billion a year can be achieved in just a few short years.

To achieve this goal, the American Diabetes Association strongly recommends an FY 1999 funding level of $545 million for diabetes research, an increase of $157 million over the President's request. Had diabetes research grown at the same rate as NIH between 1987-97, its budget would be $545 million in 1999. This level of funding would clearly demonstrate that Congress is serious about making a cure for diabetes a national priority.


Stephen J. Satalino -- Chair of the Board
Mayer B. Davidson, MD -- President
Christine A. Beebe, MS, RD, CDE, LD -- President, Health Care & Education

Posted 24 May 1998

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