Five months into FY 2003, Congress finally passed an omnibus appropriations bill for the fiscal year beginning October 1, 2002. The bill accords NIH $27.2 billion—thereby completing the promised doubling of the NIH budget five years ago.

The measure was signed into law February 21 by President Bush, who earlier that month submitted a presidential 2004 budget request that validated the cautionary words of NIH Director Elias Zerhouni late last year: NIH could be in for a bumpy landing after its five high-flying years (see "Roadblocks, Road Maps, and ‘The Perfect Storm,’" The NIH Catalyst, January-February 2003).

The president’s 2004 request would increase the NIH budget for fiscal 2004 by 2 percent, from $27.2 billion to $27.9 billion, well below the usual levels of inflation. On the heels of the president’s proposal, however, Sens. Arlen Specter (R-Pa.) and Tom Harkin (D-Iowa), long-time champions of NIH, announced plans to introduce a bill that would triple the NIH budget between 1998 and 2008. (For some details of the president’s proposed budget, see The NIH Record, March 4, 2003.)

Meanwhile, Congress has some definite ideas about how NIH should spend the money appropriated for the current fiscal year. Among the suggestions offered in the congressional "conference agreement," issued along with the omnibus bill, are the following:

NCI ought to create multi-institutional, multidisciplinary lung cancer consortia dedicated to overcoming a "pervasive sense of ‘therapeutic nihilism.’"

NHLBI, in collaboration with NINDS, ought to develop a diagnostic test for transmissible spongiform encephalopathies for screening the blood supply; NHLBI also ought to support intramural and extramural clinical trials aimed at finding a cure for lymphangioleiomyomatosis, a rare lung disorder.

NIDDK ought to launch new training initiatives to stave off an anticipated shortage of nephrology specialists.

NINDS, in collaboration with NIAID, ought to suport more controlled clinical trials on the effect of neutralizing antibodies on current multiple sclerosis therapies, as well as amass better clinical data on the effectiveness of current combination therapies; scientific workshops should be held on these issues.

NIAID is permitted to transfer $100 million of its funds to the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria. (The conferees also state that they "intend to provide NIAID with flexibility to determine the appropriate share of the Institute’s funds directed to bioterrorism research versus infrastructure.")

NICHD ought to expand research on "stem cells in the most clinically relevant models" using approved stem cell lines to study adult and embryonic stem cells in vitro and in nonhuman primates; NICHD also ought to address standards of care and rehabilitation for persons who have lost limbs, as well as sponsor a prosthetic outcomes research consensus conference.

NEI is directed to "be prepared to report on advances in research in ocular albinism."

NIEHS is commended for research initiatives on environmental influences on breast cancer and urged to establish an advisory group to advise the director in this area–and to report on progress toward creating the group in time for the 2004 appropriations hearings.

NIAMS ought to expand research to identify causes of and develop pediatric treatment options for vitiligo.

NIMH ought to study the effects of events such as the September 11, 2001, terrorist attack on survivors, emergency workers, and the general public.

NCCAM is allocated "sufficient funds to increase support for the chiropractic research center."

The NIH Director’s Discretionary Fund is doubled from the previously earmarked $10 million to $20 million so the director may pursue his "roadmap" activities.

The conferees also call for a timetable for building a new NLM facility, a comprehensive assessment of the state of autism research, an answer to any remaining questions regarding ephedra products, and a line-item accounting of research funding for temporomandibular disorders.

They invite NIA and NINDS to support more research on Pick’s disease and other t-protein–related dementias, and they ask NICHD, NINDS, NIDCD, and NIGMS to study the neurological disorder Rett syndrome, especially the effects of the newly discovered putative gene MECP2.

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