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The crisis in biomedical research funding.

Many in the biomedical research community are deeply concerned about what some have described as a crisis in grant funding. The "crisis," if it can be characterized as such, relates directly to the inability of some of the nation's best talent-often those with a long track record of funding-to obtain support from the NIH for new or continuing competitive projects. These applications have often been judged as being both important and well-conceived by scientific review panels. There are several phenomena that, in concert, are responsible for limiting the funds available for even the most meritorious proposals. The first relates to the growth in the NIH budget in the aggregate. Figure 1 shows the size of the NIH budget over the past 15 years in actual and inflation-adjusted dollars. As the top line indicates, there have been steady increases in the budget of the Institutes during this period and indeed in almost every year since their founding. Offsetting these gains in the budget, however, have been the pernicious effects of inflation. The lower line represents inflation-adjusted growth and illustrates the extent to which much of the budgetary increase has been necessary to keep the system on an even keel. In fact, after inflation, budgetary increases during the last three years-the period in which the access to new and competitive renewal funding has become most restricted-have been extremely modest-on the order of 1-3%-and the growth curve is relatively flat (1). Another relevant budgetary consideration during the last decade has been the need to address an important health concern that emerged during that period-AIDS. Beginning in 1982, Congress began designating a portion of the overall NIH appropriation for projects dedicated to a better understanding of this deadly disease. The AIDS budget has expanded dramatically since 1982, though it is a smaller share of the budget than some might guess-9.7% in FY 1991-and it is stabilizing (Fig. 2). When constant dollar growth is examined in isolation of AIDS funding, we see a slight decline in the budget between 1987 and 1990. However, it is likely that the need to confront AIDS had expanded rather