With many groups vying for disease-specific funding, a continuing debate over how research priorities are set at NIH is intensifying. The IOM committee is expected to issue its report this summer. The priority-setting process is complex and multitiered, possessing formal and informal components. In balancing the health needs of the nation with available scientific opportunities, criteria such as disease prevalence, number of deaths, extent of disability, and economic costs are weighed against technological developments and scientific breakthroughs. To find this balance, NIH relies on extramural scientists, professional societies, patient organizations, voluntary health associations, Congress, the administration, government agencies, and NIH staff.
Accomplished investigators evaluate grant applications for merit.
National advisory councils consisting of interested members of the public and the scientific and medical communities review policy. Outside experts, Congress, patient groups, the Office of Management and Budget, and other groups and agencies recommend budgetary and programmatic improvements. The final word on research programs, however, lies with the NIH director and the directors of the individual institutes. However, others are concerned that it lacks a mechanism for public input. Instead of pursuing NIH channels, many groups seeking increased research funding on specific diseases appeal directly to Congress.