Patient Services Vie For Bigger Share Of AIDS Funds

WASHINGTON-In the early 1980s, the lonely voices seeking funds for AIDS research were barely audible amid the din from the biomedical community as a whole. Over the past eight years, however, with the public also demanding that science step up its battle against the devastating-disease, the United States government has poured $5.5 billion into the AIDS epidemic, including $2.1 billion in the current year ending September 30. So far, about 40% of that total, nearly $2.2 billion, has been spent on basic research. However, while the investment in basic research has added greatly to the store of knowledge about the AIDS virus, it has not yet led to an effective treatment: much less a cure. At the same time, more people are getting sick and living longer with the disease. And their plight threatens to control the hearts and. purse strings of society and drown out those who advocate the cause of science. "AIDS is now a treatable disease," says Reed V. Tuckson, District of Columbia commissioner of health. "The implications of that are tremendous. Few health care systems are equipped to handle what's coming; nor is there much planning going on." Given the nation's limited resources, he adds, efforts to cope with the problem are "going to make Americans look like barbarians." For scientists, the overwhelming need for care forebodes a potential squeeze on scarce resources. "We have a national consensus on biomedical research," says Robert E Blendon, professor and chairman of health policy and management at the Harvard School of Public Health. But he notes that no such consensus yet exists about the need for education and appropriate care for those with AIDS, although the demand will surely be enormous. The big question for scientists is whether this demand will mean a larger slice of the federal dollar for AIDS, or simply a reallocation of the existing pie. So far, biomedical research has fared well in the scramble for funds. During this decade the government has spent twice as much on research as on education and prevention. The National Institutes of Health has received about half of the funds given to its organizational boss, the Public Health Service, and 29% of the total funds spent on AIDS. This year NIH will award 600 grants-totaling $240 million-for basic research relating to AIDS. Next year research is expected to eat up 44% of the Public Health Service's funds for HIV, leaving only 4% for patient care. But AIDS research is not a monolithic enterprise. Topics range across basic biology as well as clinical, epidemiological, behavioral, and public policy aspects of the disease. Even those who want additional spending on research have distinct ideas where that support should be channeled. "I believe that we are spending vastly too little on AIDS and are targeting some of it very poorly," wrote David E. Rogers of Cornell University Medical College in a June 15 New England Journal of Medicine editorial. He called for more education and research to determine what actually causes people to alter their behavior. Studies on such AIDS-related behavioral issues as drug addiction are emerging as high research priorities in the wake of a growing fear that infected intravenous drug users could become a sinkhole for federal dollars. The private sector may also be shifting its resources. At a recent workshop held for foundations interested in helping in the war against AIDS, experts urged philanthropic organizations to focus on services for AIDS Victims and on education, because those areas faced the greatest need. That trend can be seen even among organizations that traditionally have focused their attention on science. The American Foundation for AIDS Research (AmFAR) has raised $20 million since August 1985, three quarters of which supported research, primarily for high-risk or pilot projects of new or young investigators. But the share going to science is shrinking. In 1986, $1.6 million of $1.8 million went for research; in 1989, scientists got just half of the total $6 million raised, even though the organization receives many more proposals than it can support. In 1986, states devoted 41% of their $27 million AIDS budget for research; in 1988, only 17% was channeled to science. Fortunately, by then 37 states were Spending a total of $156 million. Even so, many in the AIDS community argue for a larger view. "To pit treatment, care, research, and prevention against one another is a mistake," says Mervyn F. Silverman, AmFAR president. "It may be a reality, but it's a mistake." Silverman worries that activists, seeing the financial strain on those who care for AIDS victims, may lobby politicians to put more money into services. But he believes that politicians should reevaluate other government expenditures before they move to curb increases for biomedical research. "A few weeks [of spending taken out of] defense could have a very significant impact on AIDS," he says.

Patient Services Vie For Bigger Share Of AIDS Funds

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