The National Institutes of Health (NIH) has just completed a period of unprecedented growth. Beginning with the base year of 1998, supporters in the United States Congress have championed and achieved a doubling of the total NIH budget allocation in 5 years. This increase followed a period of almost 15 years during which the NIH budget grew at a pace that was barely more than the rate of biomedical inflation. The doubling required budgetary increases of 14% to 17% per year and propelled the NIH budget from a total of $13.7 billion in 1998 to $27.2 billion in 1993. This increase affected all components of the NIH budget, all institutes, and all areas of medical research.
Funding in liver disease research represents approximately 1.4% of the total NIH budget and is spread among 16 of its 27 institutes and centers. The growth in overall liver disease–related research funding at the NIH from 1993 to 2003 is shown in Figure 1. Growth was modest during the mid-1990s, averaging 8% per year. During the past 5 years, however, funding in liver disease research has more than doubled, rising from $179.9 million in the index year of 1998 to an estimated $377.7 million in the recently completed fiscal year of 2003, which represents a tripling since 1993 and more than a doubling since 1998.
The final budget figures for fiscal year 2003 have not yet been completed and await the official coding of grant portfolios by the separate institutes and centers that support liver disease–related research grants. Analysis of the current portfolio, therefore, is based on the grants funded in fiscal year 2002. The 2002 budget of $348.5 million funded a total of 1,646 grants, agreements, contracts, fellowships, and awards in liver disease research. The largest numbers of grants were in viral hepatitis and infectious diseases (477), liver cancer (418) and basic cellular and molecular biology of the liver (254). Fatty liver disease (alcoholic and nonalcoholic) accounted for 128 grants, and drug- and toxicant-induced liver injury for 108. Fewer numbers of grants were coded in the specific areas of pediatric liver disease (40), genetic liver disease (39), liver transplantation (35), complications of chronic liver disease (28), autoimmune liver disease (23), gall bladder disease (13), and biotechnology and bioengineering (14). These codes, which are being used in support of the development of the Action Plan for Liver Disease Research (http://www.niddk.nih.gov/fund/divisions/ddn/ldrb/ldrb_action_plan.htm), are somewhat artificial and represent the major focus of the grants or awards, many of which focus on multiple and overlapping areas. Thus many of the basic research grants that deal with bile acid metabolism or cholestasis could also be coded as gallstone- or pediatric liver disease–related. Similarly, grants dealing with hepatic fibrosis might also be coded as relating to complications of chronic liver disease or viral hepatitis. An important shortcoming of the current coding system is that each institute or center is responsible for coding its portfolio of grants, and many have different definitions for liver-related research and different approaches to coding. Thus, studies of iron absorption and metabolism may not always be coded as related to the liver and hemochromatosis; and studies of neurological injury in Wilson's disease may not be coded as liver-related. These shortcomings notwithstanding, the analyses of the budget and current portfolio demonstrate the depth and breath of liver disease research funding by the NIH.
In the special area of viral hepatitis and infectious diseases, 279 of the 477 grants and awards (58%) were related to hepatitis C and 89 (19%) were related to hepatitis B. While 25 grants (5%) were coded primarily as dealing with HIV infection and liver disease, another 44 grants related to hepatitis B or C had components that included studies of HIV-infected patients.
Thus the period of doubling of the NIH budget has been accompanied by a more than doubling of liver disease research funding. For the liver disease research community, it is important to respond to this increased Federal commitment to liver disease–related research with real progress in our understanding of liver diseases and better means of their diagnosis, prevention, cure, and control.