The report's findings were summarized here February 16 at the annual meeting of the American Association for the Advancement of Science; the complete report, titled "A Health Planning Agenda for the American People," was unveiled one week later at a press conference in Washington, D.C.
The report covers six major areas of health care policy, including medical science, and contains proposals based on 159 principles of health care. The AMA has spent $7 million on the project since it was begun in 1982, and has collected an additional $5 million from other professional societies, drug and insurance companies, foundations and nonprofit organizations involved in the study. A total of 435 people participated in the exercise.
The report's basic prescription for medical science is more money—from the federal government, which the report said has "the primary responsibility for assuming the viability of the nation's biomedical research enterprise," as well as from private industry, foundations and state and local governments.
The additional funding should be put to several uses, according to the report. Besides increasing the number and size of grants to individual investigators, the new money should make it possible to fund a greater percentage of grants deemed worthy of support by NIH review panels, pay for more training positions to attract a steady flow of students into research, upgrade facilities and purchase needed equipment.
The report calls on scientists and their professional organizations to lobby on behalf of NIH and other agencies that fund biomedical research. NIH Director James Wyngaarden, who participated in the AAAS symposium along with Institute of Medicine President Samuel Thier and former Assistant Secretary for Health Edward Brandt, offered some advice to scientists planning to venture into the political arena.
"Be positive," Wyngaarden said in response to a question from a researcher whose renewal grant has recently been trimmed by 10 percent to accommodate the administration's proposal to delay by one year the spending of $334 million. "Present your case in terms of its being an opportunity to improve public health, to increase our scientific knowledge, and to attract the talent necessary to enable us to remain competitive with the rest of the world.
"Don't bring your personal pains to Congress," Wyngaarden cautioned. "They'll just say the government doesn't owe you a living, and that the farmers, the small businessmen and a dozen other groups are suffering a lot more than you are."
The report recommends greater incentives for companies to invest in biomedical research through changes in tax, patent and licensing laws and by shortening the time it takes for new drugs to be approved for sale. Such an investment policy, it points out, is "an exception" to its belief in "minimal government intervention" and its distaste for "special tax advantages" to selected businesses.
Surveying cooperative ventures between industry and universities, the report emphasizes the importance of clear rules on the rights and responsibilities of both parties to preserve the educational purposes of the university and allow for the profit motive of business. Other sections deal with ethical issues in biomedical research, including the impact of new technologies, the use of human subjects and the conduct of individual investigators, and the need to regulate and oversee the use of animals in research in a way that recognizes the growing strength of the animal rights movement.
The AMA hopes the report will be a guide for federal officials examining health policy questions and a yardstick for other professional societies measuring their own efforts in this area. Officials recognize the difficulty of persuading Congress to spend more money at the same time it is trying to reduce the federal deficit, but they are counting on the traditional support for biomedical research in Congress to prevail.
"Remember," Wyngaarden counseled the small but concerned audience, "this is the time of year when things always look darkest. It's before you people appear before Congress and before the appropriations committees act."