254 NATURE MEDICINE • VOLUME 5 • NUMBER 3 • MARCH 1999

NEWS

A government-mandated report chargingthe National Institutes of Health (NIH)with devoting too few resources towardstudying cancer disparity has put theNational Cancer Institute (NCI) in theposition of defending its research effortsfocused on minority populations.

In an analysis of who is most likely tosuffer a poor outcome following cancerdiagnosis, the US Institute of Medicine(IOM), a division of the National Acad-emy of Sciences, pointed to status as anethnic minority and low income as pre-disposing factors. To combat this, theIOM says that the NCI should expandefforts to learn why poor people and eth-nic minorities develop cancer and die ofthe disease at disproportionately higherrates.

The IOM said that although the NCI hasmade progress in recent years at address-ing cancer disparities, there are still gapingholes. For example, although minoritieshave been increasingly added to treat-ment studies, few have been in cancer-

NCI defends research involving minority groupsprevention trials. The 272-page report alsosuggests a reclassification of populationcategories from the one used presently,which has a more “historical,social and political signifi-cance,” to one with greaterbiological relevance. However,some members of the IOMpanel are aware of the enor-mity of this request, as it maymean an overhaul throughoutthe Health and Human Ser-vices Department.

Even though the NCI hasfunded an “impressive array”of cancer studies over the years, con-cludes the report, there has been no“overreaching strategy” to guide itsefforts in studying the medically under-served. “There needs to be a greateremphasis on behavioral studies in partic-ular, because we know that lifestyle is aquestion of behavior and impacts cancerincidence,” says Alfred Haynes, formerpresident and dean of the Drew Postgrad-

Australian research papers make the gradeAustralia’s National Health and MedicalResearch Council (NHMRC), a govern-ment body that hands out more thanAUS$160 million (US$104 million) inresearch grants annually, is trumpetingthe findings of an independent biblio-metric study that shows its grant recipi-ents are widely cited in peer-reviewedjournals. The analysis, Australian Biomed-ical Research Funding Acknowledgments andPerformance, shows that 40 percent of themost widely cited Australian biomedicalresearch papers in international journalsare sponsored by NHMRC often in con-junction with foreign funds, and 40 per-cent acknowledge funding from non-profit bodies such as the National HeartFoundation and anti-cancer councils.

The study assessed the impact of 13,620Australian publications for 1993 and1994, and discovered that the outputaccounted for 2.5 percent of all worldwidebiomedical publications. NHMRC-fundedresearch appears in the top 1 percent ofmost highly cited papers, according toWarwick Anderson, chair of the NHMRCresearch committee that commissionedthe report from the Australian NationalUniversity. “The study found thatresearch which draws support from multi-ple sources, including the NHMRC, tendsto achieve higher citation rates. Maybe

one reason is that we now give greaterconsideration to funding internationalcollaborative projects,” he says.

The most dismal performance, saysAnderson, is from industry, which con-tributed to only 8 percent of publications,in contrast to British industry that spon-sors 27 percent of UK publications.Anderson believes this is yet anotherexample of industry’s failure to getbehind the biotech revolution and sup-port academic research in the country.The Australian Pharmaceutical Manufac-turers Association (APMA) bristles at thecriticism, countering that last year itsmembers pumped $260 million intoresearch, although the focus is on appliedrather than basic research. Furthermore,some of this is commercially sensitive andcannot be published, explains APMA CEOPat Clear.

The study found only 56 percent ofpublications rely solely on Australianfunds, 17 percent list only internationalbodies—mainly from the UK and USA—and 27 percent list a combination of Aus-tralian and foreign. The really good news,according to Anderson, is that in the mostrapidly advancing fields such as cell biol-ogy and genetics, Australia is achievingbetter than average recognition.

RADA ROUSE BRISBANE

uate Medical School in Los Angeles andchair of the IOM study group.

Otis Brawley, the NCI’s director of theOffice of Special Populations Research—one of two NIH Offices criticized specifi-

cally in the report for itsinability to coordinate moreethnic research—admits thatthe document is likely toprompt the NCI to redoubleits research efforts in thisarea. But, he says, many ofthe problems of cancer dis-parities are already wellknown. “Research done atthe NCI 10 to 15 years agotold us what the problems are

and the solutions are not within ourpurview,” he says.

The IOM study group counters thatalthough social problems figure promi-nently into cancer disparities, there is stillmuch that the NCI can do. “The NCI maynot be able to change poverty, but withthe right data, we can develop strategies toreach low income populations with sur-veillance, cancer prevention, detectionand treatment,” says Susan Scrimshaw,dean of the School of Public Health at theUniversity of Illinois at Chicago and astudy group member.

Brawley is also sharply critical of theIOM’s accounting methods that esti-mated the NCI’s spending on cancerstudies in the medically underserved tobe $24 million, compared with NCI’sown calculations of $124 million. TheIOM figure, says Brawley, ignores ‘rele-vant research’, which includes studiesdesigned to detect cancer early and pre-vent or treat it. “Those studies are rele-vant to all races,” he insists. The IOM fac-tored-in only ‘targeted research’, which isfocused almost entirely on a special pop-ulation. “I hope we continue to maintaina focus on what the scientific opportuni-ties are and not less this [report] deterus,” says Brawley. A copy of the report,The Unequal Burden of Cancer, is availableat http://www.nap.edu

SCOTT GOTTLIEB, NEW YORK

CORRECTIONIn the news story, “NIH opens conflict-of-inter-est investigation” (Nature Med., 5, 129; 1999)we incorrectly reported that Richard Eastman, aresearcher at the National Institute of Diabetesand Digestive and Kidney Diseases, has receivedconsulting fees totaling $784,500 from thepharmaceutical company, Warner-Lambert.The correct amount is $78,455 over the three-year period indicated. We regret this error.

© 1999 Nature America Inc. • http://medicine.nature.com©

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