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House Bill Targets Health Economics, Evidence-Based Medicine

A flat budget for the National Institutes of Health (NIH) isn't the only unpleasant surprise for research advocates in a House of Representatives spending bill released yesterday. The draft bill, which reflects Republicans' desire to undo the 2010 health care law and trim the Department of Health and Human Services, would wipe out HHS's Agency for Healthcare Research and Quality (AHRQ), the main supporter of evidence-based medicine. The bill also bars NIH from funding economics studies.

Approved today by the House Appropriations subcommittee on labor, HHS, and education, the bill holds NIH's budget at $30.6 billion. None of NIH's funding can be spent on "any economic research," the bill states. Howard Silver, executive director of the Consortium of Social Science Associations in Washington, D.C., says the provision appears to apply to long-running surveys on aging and retirement as well as research on health disparities and the costs of illness. "Any research where socio-economic status, wealth, or income are variables could be banned," he says. According to these NIH slides, NIH funded a total of $194 million in economics research in 2009. "To outright ban certain research makes no sense," says Jennifer Zeitzer, director of legislative relations for the Federation of American Societies for Experimental Biology.

Another directive would require NIH to certify to the HHS secretary that every grant it funds is "of scientific value" and will impact public health. That seems unneeded, Zeitzer says—it's what NIH's peer review process is for.

The bill would also abolish the $405 million AHRQ, which funds studies of the value of medical treatments. The AHRQ-supported Preventive Services Task Force, an independent advisory group that evaluates screening tests and other methods of identifying people with disease risks, would be transferred to another HHS office.

The bill also targets all HHS discretionary funding for patient outcomes research. As a result, the new Patient-Centered Outcomes Research Institute (PCORI) created by the health care bill would apparently lose $150 million of its projected $320 million 2013 budget, says David Moore of the Association of American Medical Colleges in Washington, D.C.

In addition, because the bill zeroes out the HHS Prevention and Public Health Fund, which was part of the health care bill, it would trim $787 million from the budget of the Centers for Disease Control and Prevention, according to the Trust for America's Health . The administration had proposed drawing on this fund for $80 million in Alzheimer's research at NIH as well. If the bill passed, that research might have to be cancelled or funded by cuts elsewhere.

Although lawmakers may introduce amendments to save threatened programs before the full committee meets to vote on the bill, the fate of the targeted items may not be decided until the House and Senate agree on a compromise bill later this year, Silver says.