Recently, I shared with you the great news that the Senate and the House approved $138 million in fiscal year 2008 funding for the Department of Defense Breast Cancer Research Program (DOD BCRP) - $10.5 million more than last year. Some of you asked some very good questions about the federal funding process. Here are some answers.
One person asked, “Not that it’s not a worthy cause, but I don’t understand why DOD would be funding breast cancer research.”
I’m asked this question all the time. In 1992, when we were successful in significantly increasing federal funding for breast cancer research and some of the funds were in the defense budget, I was thrilled at our success but also a bit concerned. What did DOD have to do with breast cancer? It turns out that DOD has a robust biomedical research arm, incredible researchers working on things like wound healing, infectious diseases and the like. And they also work on health issues of importance to the men and women in the military and their dependents. Most importantly for our program, they have a great, efficient infrastructure and oversight in their research work. So the defense department has been a wonderful partner and administrator of these funds. The amount of money that is necessary for administration is 8%, which is unheard of in research arenas. And the dedication of the scientists who help manage these funds is astonishing. What does DOD get out of this? They have established new collaborations with scientists, have gained the respect of the outside scientific community and the advocacy movement and they have replicated the models instituted by our program in other DOD work. And this work is very much appreciated by members of the military, especially women in uniform.
It’s not just breast cancer. Because of our success, the DOD now funds several Congressionally Directed Medical Research Programs – in prostate cancer, ovarian cancer, minority and underserved populations, and several other health areas.
At the time the program was started, the federal government was only spending $100 million a year on breast cancer research. That was not nearly enough to get to the bottom of what causes breast cancer. The National Breast Cancer Coalition knew that something needed to be done, and began a grassroots effort called the “$300 Million More,” campaign in which NBCC’s nation-wide grassroots network deluged Congress with signatures, demanding an increase in federal funding for breast cancer research. Due to NBCC’s efforts and the leadership of Senators Tom Harkin (D-IA) and Alfonse D’Amato (R-NY), in 1992 Congress appropriated $210 million in the DOD research and development budget for a breast cancer research program administered by the Department of the Army. In response to NBCC’s advocacy, Congress has continued to fund this Program each year bringing its total to more than $2.1 billion for peer-reviewed breast cancer research, garnering accolades from the Institute of Medicine and creating groundbreaking advances in early detection, genetic markers, lifesaving targeted therapies and other areas of breast cancer research. And it has launched new models of research that have now been replicated elsewhere in both the military and domestic research programs and by other countries.
As stated on the BCRP’s website:
The BCRP fills important gaps not addressed by other funding agencies in support of breast cancer research. The BCRP vision is adapted yearly to facilitate rapid change and to better target funding to the most critical research areas, thus ensuring that the program remains responsive to current needs and future opportunities. A highly flexible management process with proven stewardship, well-qualified people, and productive partnerships is the key to the BCRP’s success.
Another reader, Mare, contacted us to ask: “How are the DOD monies distributed?”
Another great question with a complicated answer. The simple version - first, as we’ve discussed, Congress must appropriate federal funding for the DOD BCRP. This involves committee hearings; testimonies from experts, researchers and consumers (like myself); and vigorous lobbying and educating of the lawmakers. This is a yearlong process where the bottom line is often not settled until the last minute, with tens of millions of valuable research funding on the line.
Once that amount has been settled, a panel of outside scientists and advocates look at what gaps exist in research funding, what types of research are being ignored. This panel then develops a vision for the coming year, deciding on the types of research mechanisms that they believe will help fill the gaps. For example: Idea grants…those early ideas that are high risk, but high gain in terms of their success. The Army administrators then take that vision and publish a request for proposals to the scientific community. Researchers from across the country, and sometimes other countries, submit proposals which are then put through rigorous peer review for scientific merit, by scientists and some advocates. After they have been “scored” for scientific merit, they go back to the panel for a programmatic review. The panel looks at the scientific merit score and makes certain that the proposals meet the intent of the program and address many issues, not just a few.
As you can see, the fund allocation process alone can be a struggle in-and-of-itself. All this goes on before one penny of federal funding can be spent in the lab or the clinic. When I step back and look at it, I sometimes marvel at how far we have come.
As I have said in the past, breast cancer will not go away simply by throwing money at the problem. Getting the proper level of federal research funding is the first step. We must be vigilant to ensure that this precious funding is spent in the right place on the right research.
I’m happy to also report to you that since my previous blog post on DOD BCRP, President Bush has since signed that funding bill into law. With that piece of good news, may you enjoy your holiday season.