Daniel P. Gitterman

Child Health Research Funding and Policy: Imperatives and Investments for a Healthier World

Although pediatric research enjoyed significant benefits during the National Institutes of Health (NIH) doubling era, the proportion of the NIH budget devoted to the pediatric-research portfolio has declined overall. In light of this declining support for pediatric biomedical research, the Federation of Pediatric Organizations held a topic symposium at the 2009 Pediatric Academic Societies annual meeting as a forum for discussion of the past and future states of funding, the rationale for directing public funds toward the understanding of child health and disease, and new programs and paradigms for promoting child health research. This report of the symposium is intended to disseminate more broadly the information presented and conclusions discussed to encourage those in the child health research community to exert influence with policy makers to increase the allocation of national funding for this underfunded area.

That sinking feeling, again? The state of National Institutes of Health pediatric research funding, fiscal year 1992-2010.

This review article examines the National Institutes of Healths (NIH) overall budget and its pediatric research funding across three time periods: predoubling [fiscal year (FY) 1992–1997]; doubling (FY 1998–2003); and postdoubling (FY 2004–2009). The average annual NIH appropriations increased by 5.4%, 13.4%, and 1.3% in each period, respectively. The average annual pediatric research funding (actual grants, contracts, intramural research, and other mechanisms of support) increased much less, by 4.7%, 11.5%, and 0.3% in each period, respectively. Between FY 2004 and FY 2007, the average NIH budget increase has nearly flattened, to only 1.96%. During this period, average pediatric research funding has dropped markedly lower, to 0.57%; estimated FY 2008 pediatric funding is at negative 0.5%. Although pediatric research enjoyed significant benefits of the NIH doubling era, the proportion of the NIH budget devoted to the pediatric research portfolio has declined overall. The most recent period has wiped out the annual gains of the doubling era for both pediatric and overall NIH research funding. We offer recommendations to protect against further erosion of pediatric research funding and to implement several unfulfilled commitments to strengthen the federal pediatric research portfolio in the coming decade.

Does the Sunset of Mental Health Parity Really Matter

The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001. This article provides an overview of what the MHPA intended to do and what it actually has accomplished. We summarize state legislature actions through the end of 2000 and report on their effects on employer-sponsored mental health coverage using a national survey fielded in 1999–2000. We then discuss possible amendments to the MHPA and reforms beyond full parity that might be considered.

Designing and implementing a comparative effectiveness study of two strategies for delivering high quality CHD prevention: Methods and participant characteristics for the Heart to Health study

BACKGROUND Although lifestyle and medications are effective for coronary heart disease (CHD) risk reduction, few studies have examined the comparative effectiveness of various strategies for delivering high quality CHD risk reduction. In this paper, we report on the design and baseline characteristics of participants for just such a trial. METHODS We conducted a randomized trial of the same lifestyle and medication intervention delivered in two alternate formats: counselor-delivered or web-based. The trial was conducted at 5 diverse practices in a family medicine research network and included men and women age 35-79 who were at high risk of CHD events based on 10-year predicted Framingham risk of ≥10% or a known history of cardiovascular disease. After individual-level randomization, participants in both arms received a decision aid plus four intensive intervention visits and 3 maintenance visits over 12 months. The primary outcome was change in 10-year predicted CHD risk among patients without prior cardiovascular disease. Secondary outcomes, measured among all participants, included changes in CHD risk factors, cost-effectiveness, and acceptability at 4 and 12-month follow-up. RESULTS We randomized 489 eligible patients: 389 without and 100 with a known history of cardiovascular disease. Mean age was 62.3. 75% were white, 25% African-American. 45% had a college education. 88% had health insurance. Mean 10-year predicted CHD risk was 16.9%. CONCLUSION We have successfully recruited a diverse sample of practices and patients that will provide a rich sample in which to test the comparative effectiveness of two strategies to implement high quality CHD prevention.

Obama Lies, Grandma Dies: The Uncertain Politics of Medicare and the Patient Protection and Affordable Care Act

As savvy researchers, we Googled our topic: “Obama and Medicare.” Our first hit was zazzle.com, which advertised a bumper sticker with an older woman in a wheelchair hurtling down a slope with the caption “Obama Lies, Grandma Dies.”1 The bumper sticker captures the politics of health care reform and Medicare. In the summer of 2009, congressional town hall events became shouting matches over health care reform, and the Medicare program found itself front and center in the political battle. Here are snapshots from August 2009:

The Fragile State of the National Institutes of Health Pediatric Research Portfolio, 1992-2015: Doing More With Less?

In this article, we examine the status of the National Institutes of Health (NIH) pediatric research portfolio between start of federal fiscal year (FY) 1992 and end of FY 2015. The NIH experienced the greatest mean annual growth rate during the “doubling era” (FY 1998-2003): both the NIH budget (13.5%) and pediatric research portfolios (11.5%) increased annually by double digits. However, in the “postdoubling” era (FY 2004-2009), both the NIH (2.0%) and pediatric (−0.2%) mean annual growth rates decreased dramatically. In the most recent era (FY 2010-2015), the NIH mean annual growth rate has been flat (−0.1%) and pediatric research funding has posted very modest gains (3.5%) without accounting for 1-time increases under the 2009 American Recovery and Reinvestment Act. We offer recommendations to protect against further erosion of the pediatric research portfolio because continuation of these trends will have a negative effect on the health of children during their childhood and as adults. As capacity to conduct basic and applied research is further constrained, it will be a challenge for pediatric researchers to do more with less and less.

The uncertain fate of the National Institutes of Health (NIH) pediatric research portfolio

Background: The amount of federal dollars allocated to improving the health of our pediatric population can serve as an indicator of the priority placed on child well-being. Although Congress has established novel mechanisms that marginally increase pediatric research funding, the pediatric research portfolio is facing an increasingly uncertain fate. Methods: This work examines pediatric, perinatal and pediatric research initiative (PRI) spending using data collected by the NIH that uses the novel research, condition and disease categorization system. Further, this work reports on recent policy developments in pediatric biomedical research and offers recommendations to insulate this portfolio from future uncertainty. Results: Federal support for pediatric research has declined with average annual growth rates of NIH pediatric spending dropping from 12.8% (FY 1998-2003) to 1.7% (FY 2004-2015). After taking into account Biomedical Research and Development Price Index growth, the pediatric research portfolio’s purchasing power has declined by 15.9% (FY 2004-2015). Conclusion: Federal support for pediatric biomedical research has plateaued in nominal terms and declined significantly in real terms. Future congressional action will be necessary to protect gains and to expand the capacity of the pediatric portfolio.

A Way Forward

Corruption recovery is a critical but understudied organizational change. We gained unique access to a company that experienced multiple corruption incidents in the months prior to our survey rollout that garnered 2,300+ respondents (71%) across 19 business units. We explored how employee perceptions of leaders’ enactment of a core set of values and of CEO and business unit leaders’ ethical leadership were associated with organizational commitment as these leaders implemented change following corruption. Results indicated that ethical leadership and values enactment were associated with increased organizational commitment. Group-level membership in units implicated in corruption was associated with reduced commitment while membership in business units with increased customer contact was associated with increased commitment. Shared employee perspectives of the ethical leadership of business unit leaders, but not the CEO, were also associated with higher commitment. We also discuss future research, limitations, and implications for management.

Can “Some College” Help Reduce Future Earnings Inequality?

This article addresses the policy debate over “college for all” versus “college for some” in the United States and analyzes the relationship between “some college” (as a formal education attainment category) and earnings. Our evidence confirms—using data from the American Community Survey (ACS), the Panel Study on Income Dynamics (PSID), and the Survey on Income and Program Participation (SIPP)—that more (postsecondary) education, on average, is associated with higher median earnings. However, there is emerging evidence that a proportion of workers who have attained lower levels of education (i.e., “some college”) earn more than those who have attained higher levels of education (bachelors degree). We focus particular attention on the subset of Americans who fall into the U.S. Census official category entitled “some college.” This is a heterogeneous group who have alternate educational credentials but who have not acquired a formal associate or bachelors degree. Instead of an unequivocal focus on “college for all” or even “community college for all,” we argue that educators and policymakers should consider “some college” as a viable pathway to future labor market success. In sum, we conclude that some types of “some college” could lead to a reduction in earnings inequality.