By: David Warmflash
The short answer to the question in the title is YES. Given information provided by the National Institutes Health (NIH), medical research funding reflects the proportion of troubles imposed on society by diseases, although not perfectly. The details are complicated; they paint a picture saying that some conditions, categories of conditions, or topics, receive more government money than they “deserve” compared with others, but there’s an overall correlation between funding and need.
Laying Out the Question
A logical, simple question is whether disease X, which has a high incidence, morbidity, and/or mortality, receives proportionately more funding than disease Y, which has a low incidence, morbidity, and/or mortality. Incidence refers to the number of cases per given number of people, what percentage of the population is afflicted. Morbidity is the damage that the disease inflicts on the person who has it, and mortality is the rate at which the disease kills. To help determine whether funding allocation is fair, NIH has considered incidence, morbidity, mortality, and other disease factors together as disease burden, and placed the various health conditions, and topics (including basic research and lump categories, such as “behavioral science”) into a table with funding for different fiscal years listed in millions of dollars. They also have divided disease burden in to two main categories: disability adjusted life years (DALYs) and deaths. Both DALYs and deaths are considered nationally and globally in graphic form, such that we can go disease-by-disease, research category-by-research category, to assess funding versus DALYs and death for the U.S. population, and for the global population.
Comparison of NIH Funding for Diseases and Research Categories
On the graphs as they are posted on the NIH site, moving the cursor over each datum reveals the disease or research category that it represents. Looking at the four graphs, we can see that the data generally slope upward moving from left to right. If you draw a line through the highest concentration of data, the line has a positive slope. That’s good, since it means overall that more health burden correlates with more funding, but the data are nevertheless dispersed from that line. Data above the line represent diseases and research categories with “too much” funding, whereas data below the line represent underfunded conditions and topics.
While all four plots show dispersed data, they differ in the degree of dispersion. They are more scrunched, following a line pattern more closely, in the plot of funding versus global DALYs, compared with funding versus U.S. death, versus global death, and versus U.S. DALYs. This suggests that funding is most appropriate when it comes to global DALYs.
Underfunded and Overfunded Research Condition and Disease Categories
Though somewhat better on the global DALYs graph, all four graphs have many data located too high or too low compared with the imaginary line that we can draw through them. Some of those data stand out from the rest. Hepatitis C, for instance, is fairly far to the left on the burden axis (x), and high on the funding (y) axis, in all four plots. In other words, it receives fairly more funding than we might expect given its burden. Hepatitis B is also in this category, and so is mental health. At the opposite extreme are conditions and categories to the right and below the imaginary line. These include accidents/injuries, lung conditions, headache conditions, and suicide.
Forces Underlying Disproportionate Funding
Determining why a category or disease gets more or less funding than we’d expect based on its burden probably requires a very complex equation, involving economics, politics, as well as details related to how good researchers are at writing their grant proposals. But one clear factor is the lobbying power connected with the different conditions. A 2014 article in Nature explains how lobbying by patient advocacy groups has had particularly dramatic effects on government funding for what are called “rare diseases.”
A University of Michigan study that is cited in the aforementioned Nature article found that every $1,000 of lobbying translates to about $25,000 of funding increase for research, so it really pays off for the patient advocates. On the other hand, the fact that the data can be visualized with any scrunching at all into an upward slope suggests that generally the government is doing a fairly good job in proportional allocation. This says nothing about whether the total numbers are appropriate, of course. After all, wouldn’t we all welcome a lot more funding across the board?
David Warmflash, M.D., is an astrobiologist, science writer, and physician. He is principal investigator on a Planetary Society-sponsored investigation of the effects of the space environment on organisms.