Former Washington Post health care reporter Rick Weiss has moved over to the Center for American Progress, where he contributes to Science Progress, a one-year-old science policy magazine. Today, he posted an article decrying the decline in funding for the National Institutes of Health (it's been flatlined for most of this decade), and asking "Where's the Biomed Bailout?"

I posted this response:

I am a fervent supporter of more public sector support for research, but by focusing exclusively on NIH, you are missing the larger opportunity for medical innovation that is more pressing at this point in time: the need for new and better ways to deliver health care and promote health. For the vast majority of diseases, we need better ways of delivering old innovations and better ways of preventing disease, not ever evolving ways of curing it.

Let’s look at the issue in budgetary terms. The U.S. spends about 2.8 percent of its $2.4 trillion annual national health expenditures budget or about $67 billion on public health. That means NIH is getting nearly half of all money with CDC, AHRQ, WRAIR, all state and city public health departments, and private and non-profit efforts dividing the rest. The total would be even less if NIH hadn’t gotten a major $2 billion annual infusion from the war on bioterrorism, which many would argue has skewed research priorities in the infectious disease arena.

So by all means, let’s raise our voices for more money for public health and public research. But let’s simultaneously talk about priorities and competition for scarce resources within this embattled community, and priorities within NIH. Given the poor performance of the U.S. health care system, we cannot allow the debate to be hijacked by well-funded patient lobby groups who peddle the “diseases that would have been cured in the next five years if only we had more money for research” line. That may have worked in the late 1990s, but it doesn’t address the health care system’s present needs.

Moreover, anyone with even a passing familiarity of the research and development process that leads to discreet biomedical interventions as a way of curing disease knows that the translational process from NIH-funded basic science to validated targets to actual cures is far more complex, usually more time-consuming, and an often fruitless endeavor than the guilt-inducing formulation — “I would have been cured if only the government spent more money on research” — would allow.

Please don’t take this to mean I am against more money for NIH. But they are just one agency out of many in our government that has been systematically starved for funds over the past decade.

The next president will get a chance to pick a new leader at NIH, whose extramural grantees seem to be embroiled in a never-ending string of conflict-of-interest scandals. He or she should open a public discussion about the agency’s priorities with its existing funds, and engage the entire public health community, of which it is only one part, in the discussion about what are the next great opportunities in health and health care innovation.