Grassroots Advocacy Visible From 30,000 Feet
By George Weiner, MD
Dr. Weiner is from the Holden Comprehensive Cancer Center at the University of Iowa.
Editor's Note: This is the first in a series of articles illustrating how hematologists can become involved with the presidential election. ASH members are encouraged to take advantage of opportunities to become involved in the election and particularly to share their views about health-related issues with the candidates.
As an Iowan, I accept the fact that most influential members of national government and media consider Iowa "fly-over" country. That is, of course, except for once every four years when the Iowa Presidential Caucuses take place.
The Iowa Caucuses are a remarkable tradition. National political campaigns focus on reports from pollsters, production of political advertisements, and participation in staged events. The grassroots nature of the face-to-face interaction that takes place during the Iowa Caucus is very different. During the Caucus, dialogue takes place that would not be possible from 30,000 feet. Over a period of months leading up to the Caucus, Iowans meet the candidates in person in intimate settings and are not shy about asking questions that, in a typical Iowa way, are challenging but untinged by arrogance or cynicism. We become a state of policy wonks where dialogue among family and friends focuses on the relative merits of the various candidates. A man dressed in overalls and a baseball cap is as likely to ask a candidate about Medicare Part B, stem cell research, or Darfur as he is about farm policy. Iowans learn where the candidates stand. More importantly, the candidates learn from talking to citizens in an unscripted fashion. Anyone with an opinion who is willing to make the effort can be heard. As the process progresses, the candidates refine their positions based on this dialogue.
As my neighbors and fellow Iowans did, early in the process, I reviewed the policies put forth by various candidates. One of the candidates (to whom I will refer to as "Candidate X"), spoke about his/her support for biomedical research when asked, but had not addressed such research in his/her formal platform. I took an opportunity to contact Candidate X's staff, and offered to share my thoughts about the importance of biomedical research. In a move that would have been highly unlikely in a national campaign and only possible in Iowa, a couple of weeks later, I found myself seated next to Candidate X in a motorcade going from Des Moines to an appearance he/she was making in Ankeny, Iowa, expressing my concern that his/her formal platform did not address biomedical research. Candidate X was fully engaged in our discussion and asked excellent questions as we talked about biomedical research, health care, and disease prevention, and he/she asked me to provide comments for his/her platform based on the principles we had discussed to his/her staff. I have no doubt similar discussions about other issues took place around the state with all of the candidates.
Now, the Caucuses are done, and all is back to normal in Iowa. The politicians and national media have packed up and returned to the centers of power, and Iowa is content to be fly-over country once again. Iowa's role in the process of selecting presidential candidates has received considerable criticism as being disproportional, and it is unclear whether we will have the opportunity to serve in this unique capacity again. Nevertheless, as an Iowan, I am proud of the role our state played in the process and believe the nation is well served by presidential politics beginning at the grassroots level where individual voices can be heard.
Visit the Policy and Practice section of the ASH Web site to read about the presidential candidates' positions on health-care reform, Medicare, stem cell research, biomedical research funding, and other health-related topics.
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ASH Continues Advocacy Efforts as Funding Increases Slow for NIH
By Roy Silverstein, MD
Dr. Silverstein is Chairman of the Department of Cell Biology and Vice-Chair for Translational Research at the Lerner Research Institute. He is also Chair of the ASH Committee on Government Affairs.
The National Institutes of Health (NIH) is by far the most important source of funding for clinical and basic hematology research in the United States. After an unprecedented period in which the NIH budget doubled over a five-year period and many significant discoveries and advances were made, recent budget increases have slowed to a crawl, not even keeping up with biomedical inflation.
Unfortunately, this devastating trend held true again in fiscal year (FY) 2008. The budget appropriations process began last winter with the President requesting a funding level 0.8 percent below the previous year's funding. Intense advocacy efforts by ASH and others in the biomedical research community ultimately led to House and Senate negotiators reaching an agreement in early November on legislation containing a net increase in FY 2008 funding for NIH of 3.1 percent over the FY 2007 level.
Although the 3.1 percent increase provided by Congress was a major victory for ASH and NIH supporters, the victory was short-lived. President Bush vetoed the bill on November 13, 2007, because total domestic discretionary spending exceeded his requested level. The final budget that was passed in December 2007 and signed by President Bush included a mere 0.46 percent increase for NIH over FY 2007 levels. These numbers are particularly disturbing in light of the fact that the rate of biomedical inflation for the coming year is expected to be 3.7 percent.
As this issue of The Hematologist was going to print, President Bush was readying the release of his proposed FY 2009 budget, which initiates the annual appropriations process. Unfortunately, with the continued war in Iraq consuming enormous resources and a gloomy national economic forecast, there will again be reluctance to increase discretionary funding for important domestic programs such as NIH. Securing adequate funding for NIH in FY 2009 will likely prove to be an uphill battle. At times like these, a loud and consistent voice is needed. The ASH Government Affairs Committee will continue to promote the ASH legislative agenda, and we encourage all ASH members to participate in the Grassroots Network and ASH advocacy campaigns to ensure that Congress listens and responds to our concerns. ASH will launch grassroots campaigns to increase NIH funding appropriately and will keep the membership apprised of all developments through future issues of The Hematologist, the ASH Web site, and the electronic newsletter Advocacy Update.
For more information about the Grassroots Network, visit the ASH Advocacy Center.
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Headlines From Washington
ASH Fights Shortfall in President Bush's NIH Budget
On Monday, February 4, President Bush released his fiscal year (FY) 2009 budget proposal, which included $29.3 billion in funding for the National Institutes of Health (NIH). By means of comparison, the final FY 2008 funding bill that passed in December 2007 contained $28.942 billion in funding for NIH.
The President's budget request is a starting point for the annual budget process, and Congress will begin its hearings and debate. ASH will implement advocacy efforts during the FY 2009 budget debate and encourages all members to "Take Action."
March is DVT Awareness Month
March is Deep Vein Thrombosis (DVT) Awareness Month. ASH is working with several advocacy coalitions, the U.S. Surgeon General's office, the Department of Health and Human Services (HHS), the National Heart, Lung, and Blood Institute (NHLBI), and the Centers for Disease Control and Prevention (CDC) on efforts to increase public awareness of DVT as a major public health problem, and as an area of exciting new developments in both clinical and basic research.
NIH Sets FY 2008 Fiscal Policy for Grant Support
The NIH set its FY 2008 policy for grant support based on the final FY 2008 appropriations legislation that was enacted in December. Because Congress increased NIH's budgetary support by only 1 percent, NIH is not able to fully cover its 3 percent inflation commitment for non-competing research awards. Meanwhile, competing research award grant sizes may increase by 1 percent in accordance with the legislated increase.
NIH's policy requires each Institute and Center to "use its own discretion to allocate the (1 percent) adjustment among its non-competing research grants." However, the policy does not apply to Career Development Awards, Small Business Innovation Research and Small Business Technology Transfer Grant Awards, and Ruth L. Kirschstein National Research Service Award Individual Fellowships and Training Grants. For non-competing grants awarded during the continuing resolution (awarded at approximately 80 percent of the previously committed level), NIH will revise the amounts to reflect the new policy.
NIH estimates the FY 2008 appropriation should provide for 9,700 new and competing research project grants. In addition, NIH plans to retain the same number of new investigators as averaged in the past five years, continue the NIH Director's Innovator Awards and NIH Pathway to Independence Awards, and utilize the NIH Director's Bridge Award Program "to help balance the grant cycling variation challenges and support other approaches to sustain established grantees and first-time competing renewals."
FDA to Re-Examine Safety of ESAs
As this issue of The Hematologist was going to press, the FDA announced that its Oncology Drug Advisory Committee (ODAC) will be having a meeting on March 13 to discuss data concerning the safety of ESAs. ASH will be testifying at this meeting. Also, ASH has developed several resources for practitioners concerning use and coverage of ESAs. The "Use of Epoetin and Darbepoetin in Patients with Cancer: 2007 American Society of Hematology/American Society of Clinical Oncology Clinical Practice Guideline Update" and ASH's free Quick-Reference Pocket Guide summarizing the guideline can be found in the "Practice Resources" section of the ASH Web site. ASH's Model Policy on MDS for Local Medicare Carriers is available online. For more information concerning new reporting requirements on Medicare claims for the administration of ESAs, visit the Policy and Practice News section of the ASH Web site.
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Take Action
The release of the President's FY 2009 budget proposal initiates the annual appropriations process for the year. Last year, the NIH received $28.942 billion, an increase of $133 million (+0.46 percent). Such continued small increases for NIH — well below the rate of biomedical inflation — will make it extremely difficult for hematologists and other health professionals to train promising researchers, create research advances, and improve the health of all Americans. Continued funding shortfalls may force NIH to choose between ongoing basic research efforts and new clinical research activities, resulting in an overall slowdown in medical discoveries.
President Bush has indicated a continuing desire to reduce the federal budget deficit, meaning federal agencies and departments, such as NIH, are likely to face a difficult time in securing additional funding. Therefore, it is crucial for all researchers to contact their Senators and Representatives to help ensure that Congress gets the message that both hematologists and their patients want the House and Senate FY 2009 budget proposals to include more funding for NIH research. Early and continued grassroots advocacy is crucial to ensuring adequate funding for NIH in FY 2009.
To contact Congress and urge support for additional NIH funding, visit the ASH Advocacy Center.The Advocacy Center identifies your Senators and Representatives by ZIP code and then sends a letter via e-mail to the proper offices.
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