Money Remains Sincerest Form of Concern in Research

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WASHINGTON -- Anyone looking for proof of the political clout attached to women's health issues can find it in the place that provides the truest test of such importance: the fine print of the federal budget process.

The congressional committees that write the government's health- research budget have studded their reports in recent years with demands for more research on disorders, large and small, that predominantly affect women. Such prodding has helped create a top- level office in the National Institutes of Health to oversee research on women's ailments, and a similar post, deputy assistant secretary for women's health, for the Department of Health and Human Services.

The government will spend more than $550 million this year on breast-cancer research, which is expected to kill 44,200 Americans in 1997 -- more than it spends to study lung cancer (160,400 deaths), colorectal cancer (54,900), liver cancer (12,400) and Hodgkin's disease (1,480) combined. That, and more, is the reward for a decade of political and scientific grunt work by women's groups and their allies in Congress. And they say they are not through. "We're playing catchup," said Joanne Howes, a partner in an all- female lobbying firm here, which specializes in drumming up support for research into disorders affecting women. Catchup, in this view, means compensating for decades in which researchers excluded women from critical tests of new drugs and, Ms. Howes and others say, generally gave their health problems short shrift. Not everyone fully subscribes to that view. But among the people who count in Congress and the White House, there are few such doubts. The allotment for women's health in the latest budget of the Department of Health and Human Services -- which covers most federally financed research -- is $2.3 billion, up 30 percent in three years. Advocates of specific diseases haven't done too badly either. Take the case of the National Fibromyalgia Research Association, which trumpets its success on its Web site: "Personally lobbied Oregon Senator Mark Hatfield and staff, resulting in aggressive wording in the U.S. Congressional Appropriations Committee's recommendation to the National Institutes of Health regarding fibromyalgia." Fibromyalgia, a cousin of chronic-fatigue syndrome, affects mostly women. The institutes allotted $1 million for research three years ago. Hatfield, the chairman of the Senate Appropriations Committee until his retirement last year, met with a senior NIH official last fall for a briefing on the disorder. A top institute official later sent Hatfield a letter announcing three new grants for fibromyalgia research and plans for a fourth grant on a related issue -- sleep disorders. How much sway such recommendations hold is anyone's guess. Legislators swear they do not intend to play politics with scientific judgments. Dr. Vivian Pinn, the head of the NIH's Office of Research on Women's Health, says politicians' pet concerns receive attention, but are judged primarily on their merits. "We certainly recognize these are important issues, and we look to see if there really are gaps in our knowledge," she said in an interview, but "the institutes really decide most of what they do on a scientific basis for the most part." Fibromyalgia is just one of a host of women's health problems pointedly mentioned in recent Appropriations Committee reports, almost always because of lobbying by constituents or interest groups. The House offers friendly advice to put "special emphasis on grants relating to interstitial cystitis," an uncommon and debilitating bladder condition, and to "pursue new projects" that could help prevent or control diabetes in women. …