Does NIA Spend Too Much On Alzheimer's?

Too Much On Alzheimer's? Author: Steven Benowitz Date: February 19, 1996 The National Institute on Aging (NIA) spent approximately $216 million last year-practically one-half of its 1995 total budget of $433 million-on research related to Alzheimer's disease. Overall, the National Institutes of Health funded some $311 million in Alzheimer's-associated work. Concerned: Richard Adelman worries about a lack of money for basic aging science. Is that too much? Is spending that much on Alzheimer's work hurting studies in other areas of aging, such as basic biology? Richard C. Adelman thinks so. Adelman, director of the Institute of Gerontology and a professor of biological chemistry at the University of Michigan, is concerned that NIA is focusing too many of its resources on Alzheimer's disease and not enough on the basic science of aging. Yet Adelman doesn't blame NIA for carrying out a congressionally mandated mission to study Alzheimer's, which afflicts approximately 4 million Americans. "Alzheimer's research will generate basic research vital to the understanding of aging and other fields," he asserts. "You can't criticize the research funding and the way NIA spends its dollars. But my message is that a fundamental understanding of aging might just as well come from research that has nothing to do with aging-as might a cure for Alzheimer's." Adelman stresses a balance between clinical and basic research support-"not redirecting science funding at the cost of applied." Many disagree with him. While they see a need for balanced funding, they contend that a variety of discoveries in the neurosciences and cell biology have come from research focusing on Alzheimer's, and have applications in understanding aging. John Trojanowski, director of the University of Pennsylvania's Alzheimer's Disease Center and a professor of pathology and laboratory medicine, argues that NIA's Alzheimer's research efforts go beyond the field of aging. "The Alzheimer's disease program is not exclusively disease-oriented-a lot of basic biology is being done on brain structure, function, molecular biology, and gene cloning," he says. "To say [the program] funds only clinical research is blatantly inaccurate. The impact the Alzheimer's research agenda has on other aspects of aging of the nervous system is incredible. "Much of the NIA-funded basic biology has applications to [several diseases, such as] amyotrophic lateral sclerosis and Parkinson's disease," notes Trojanowski. "Alzheimer's may be a model for approaching aging because it's polygenic and heterogeneous," he says. "You could argue the opposite of what Adelman says-that Alzheimer's is the star performer in the NIA portfolio, and the related discoveries ripple through all aspects of the biological basis of the study of aging as well as disease." He points to a "bandwagon effect" of Alzheimer's disease that has opened opportunities for funding to study various aspects of the disease and has attracted basic researchers, mostly neuroscientists. On the other hand, cell biologist Leonard Hayflick, a professor of anatomy at the University of California, San Francisco, takes Adelman's stance one step further. Hayflick argues that solving the biological and behavioral riddles of Alzheimer's won't help researchers understand how the aging process works. "It's erroneous to believe that understanding diseases associated with old age will give us insight into the basic mechanisms of aging," he declares. "The resolution tomorrow of Alzheimer's will not advance our knowledge of the fundamental biology of aging in the same way that the resolution of polio did not advance our understanding of child development." Adelman believes that "we need to target Alzheimer's, but we also need to target other kinds of basic research that isn't directly related," such as fundamental studies in the biology of the aging cell. NIA "forces those who apply for funds to justify research in the context of Alzheimer's," he says. "There shouldn't be any criteria, anyone forcing fundamental research to relate to a disease. There should be just as much opportunity to propose research not remotely related to Alz-heimer's." In an August article in the journal The Gerontologist (R.C. Adelman, 35[4]:526-32, 1995), Adelman writes of a struggle between interest groups-physician-scientists on the one hand vs. basic researchers on the other-"for the power to shape the future directions of science" in gerontology. NIA administrators respond that while they understand Adelman's frustration, they are convinced that the institute's funding priorities should remain. Gerontologist Terrie Wetle, deputy director of NIA, defends the institute's funding mechanism. All NIA research is peer-reviewed, she says, and support is determined by scientific merit. "A great deal of the work supported by NIA that's labeled Alzheimer's is basic research examining genetics, aging of neurons, normal and disease-related aging-you can't say it's basic research vs. Alzheimer's." BALANCING ACT: NIA head Richard Hodes struggles to balance applied and basic research funding. NIA director Richard Hodes, an immunologist, notes that the institute and NIH both generally try to balance funding for applied and basic science, though he admits to "a constant struggle to balance" the two in Alzheimer's research. "Alzheimer's research has yielded its share of serendipitous discoveries," he points out. "Genes associated with the disease were discovered by those interested in cardiovascular disease and lipid metabolism, and not as the potential cause of Alzheimer's. "It's a goal to make certain that the human application-the translation of basic science-is carried out," Hodes says. He notes that other institutes share similar interests in basic cell biology, including the regulation of cell growth and senescence. He believes that Congress and the public are becoming increasingly aware that research into the treatment and eradication of disease should include an investment in basic science. INNOVATOR: Geriatrician Robert Butler, NIA's founding director, began its focus on Alzheimer's research. Founding NIA director and geriatrician Robert Butler is a firm supporter of the government's commitment. For NIA as well as other NIH institutes "to spend some $311 million on Alzheimer's disease research, which is the fourth leading cause of death, is not only justified, but the Office of Technology Assessment a few years ago said we should spend $500 million," notes Butler, who is now director of the International Longevity Center and a professor of geriatrics at Mount Sinai Medical Center in New York. But he thinks that NIA should have a much broader mission-"not [more than] 45 percent of its research budget devoted to one disease. There should be more dollars available for studies on osteoporosis, the impact of retirement, the psychology of aging, the basic biology of aging-a balance." Butler takes credit-or blame-for the so-called Alzheimerization of aging. During his tenure as NIA director, from 1976 to 1982, Alzheimer's research became a major institute focus. In 1976, two years after NIA was established, Butler realized that focusing research on a disease, as had many of the other institutes, would be an important vehicle through which to attract dollars from the federal government and, he hoped, help his institute flourish. His own research interests were in dementia, "so I made up my mind that Alzheimer's disease would become a household word in the country-after I made sure that my personal interest was justified by the epidemiology of the disease-that it was a leading cause of death and that neurobiology was sufficiently advanced," he recalls. "It was such a devastating condition and so little money was devoted to it, I felt justified." Making Alzheimer's NIA's emphasis "was done by a process of getting together people to lobby and testify before Congress, conducting public hearings, and submitting plans of action," he explains. Butler and his colleagues also began to gather several of the regional Alzheimer's support and advocacy groups together under the umbrella of the Alzheimer's Disease and Related Disorders Association. The Chicago-based organization has since shortened its name to the Alzheimer's Association. In 1976, when the institute began, little of the NIA research budget-perhaps 15 percent-supported Alzheimer's disease work. Most of NIA research dollars went to fundamental biology. The institute strengthened its commitment to Alzheimer's research by launching the Centers Grants Program in 1983, when Congress, concerned about Alzheimer's as a growing public health problem, appropriated $2.5 million. According to Adelman's article, "the impact of the commitment to Alzheimer's disease is most significant in the context of the NIA Centers Grants Program, which influences directions of science in gerontology in ways that other NIA funding mechanisms generally do not." The centers program promotes research, training, and education, as well as technology transfer and multicenter and cooperative studies of Alzheimer's diagnosis and treatment. By 1994, NIA was spending some $35 million on 28 Alzheimer's disease centers. Aging research, Butler notes, has seen an explosion of interest in the past decade. He points to a 1991 Institute of Medicine (IOM) report-Extending Life, Enhancing Life: A National Agenda on Aging (Edmund Lonergan, ed., Washington, D.C., National Academy Press)-in which an IOM committee concluded that a "major investment in research on aging is needed urgently" (K.Y. Kreeger, The Scientist, Oct. 17, 1994, page 14). Today, NIA shells out roughly $163 million to its neuroscience and neuropsychology program, the largest of four extramural programs, which supports applied and basic Alzheimer's research, including the centers program. The majority of the neuroscience dollars support Alzheimer's-related work. Another $53 million funds Alzheimer's research in the other three NIA extramural programs-the biology of aging, geriatrics, and behavioral and social science-as well as the intramural laboratories and an epidemiology program. NIA has used Alzheimer's disease as a vehicle to attract government and public funding support, unfortunately at the expense of the basic science of aging, Adelman contends. "It's perfectly reasonable to declare war on disease," he says. "The problem is that Congress and the public tend to listen and respond to the emotion generated by the impact of disease. Basic science has a difficult time making its case." Adelman faults a basic science community that is lax in its advocacy of basic research aimed at understanding the fundamental aging process. The Alzheimer's movement "has done its advocacy very well, whereas the basic science community has always struggled," he maintains. He notes the particularly effective congressional lobbying efforts of advocacy organizations such as the Alzheimer's Association. His plea to colleagues: "Do what the Alzheimer's disease advocates do and get Congress to listen." Basic biology, however, can be a tough sell. "In the public's mind, Alzheimer's is far sexier than the fundamental biology of aging," comments Hayflick, who is the author of How and Why We Age, published by New York-based Ballantine Books in 1994 (E. Garfield, The Scientist, May 15, 1995, page 12). "The public can better understand the concept that it's good to cure a disease that causes suffering, but you can't get the simple concept across to the public that the fundamental question of aging is why is an old cell more susceptible to disease than a young cell. Consequently, [studying a disease] is a much easier concept to get across to Congress. They all have a relative or know someone who has Alzheimer's. They can't relate to basic biology." He suggests a program be begun immediately by NIA to educate the public "that the real problem is not heart disease, cancer, or Alzheimer's. The institute should devote its energies and money to study the fundamental biology of aging-or at least in proportion to its importance." HOPEFUL: Researcher Vincent Cristofalo thinks Adelman's article may "create a sensitivity" at NIA. The argument for greater balance in aging research funding isn't new, notes Vincent Cristofalo, director of the Center for Gerontological Research and vice provost for research at the Medical College of Pennsylvania and Hahnemann University in Philadelphia. Adelman's article in The Gerontologist "has called attention to a problem publicly," Cristofalo says. "But this general discussion has been going on for 15 years. Writing an article in a journal with a circulation of 10,000 has called attention to it and may create a sensitivity at NIA that might get the institute administration to think about the justification for funding allocations." Reactions to the piece have been mixed. While Cristofalo-who studies the cellular and molecular biology of aging-agrees with Adelman's call for more balanced funding, he thinks the article has been widely misunderstood. "I've sat at meetings since the article came out [in August] and have seen different reactions," he says. "Clinicians who are involved in Alzheimer's read only the part that the budget was too big for Alzheimer's and those who are in basic biology agreed that the money is poorly allocated. This is an instance in which people read an article with passioned biases." Cristofalo adds that ultimately, "I think this [article's] visibility on the issue may help bring more balance in funding."

Does NIA Spend Too Much On Alzheimer's?

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