Books Review Essay

Does the structure of NIH impede the charting of future directions that might pay large dividends? The confluence of three factors make such questions as these particu-larly salient. First, choices about how research dollars are apportioned now may help determine the existence of future treatments as well as overall health care costs. These are significant matters at any time, but especially so in the present political climate with the growing concern over the soaring national health care bill. Second, the magnitude of the federal government research enterprise elevates its decision making regarding research priorities to the level of a critical issue. The federal government is the single largest sponsor of medical research, and the vast majority of its research money is appropriated to NIH. A bipartisan congressional drive, currently proceeding successfully, may double NIH’s annual budget over five years, from $13 billion in 1998 to $26 bil