Science
20 November 2015 vol 350, issue 6263, pages 885-1000
http://www.sciencemag.org/current.dtl

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Feature
What does a disease deserve?
Jocelyn Kaiser
Since the early 1990s, Congress and the National Institutes of Health (NIH) have agreed to dedicate roughly 10% of the NIH budget to fighting HIV/AIDS. Now, however, that special arrangement is under fire. Health policy experts, lawmakers, and even NIH officials have wondered why, 2 decades after AIDS death rates began dropping dramatically in the United States, the disease still gets a lion’s share of NIH resources, or $3 billion this year. As questions have arisen about how HIV/AIDS research funds are spent, NIH has also resolved to refocus AIDS money on ending the epidemic. Some voice a broader critique: that NIH’s spending on a disease often doesn’t align with how much suffering it causes. They note that diseases imposing a relatively small burden on U.S. society, such as AIDS, can get a larger share of NIH funding than those that cause greater harm, such as heart disease. Recently, while responding to pointed questions from a member of Congress about the issue, NIH Director Francis Collins said the agency is ready to abandon the 10% set-aside. And next month officials are expected to release an agency-wide strategic plan that they say will address how disease burden should influence the allocation of research dollars.