I was delighted to be able to address the leaders of NCI and the Comprehensive Cancer Centers at their retreat on May 2 (see Director's Update). It was an excellent opportunity to provide some background and context on the forces that are driving NIH's current budget environment and the impact on maintaining the cancer research community's astounding progress in stimulating a paradigm shift in cancer care.

Support for NIH's mission remains strong across the nation and among members of the U.S. Congress. But we are in the midst of a difficult transition period as the federal government grapples with emerging priorities involving the national defense, homeland security, the aftermath of Hurricane Katrina, and costly - albeit necessary - preparations in anticipation of a pandemic influenza outbreak.

We are also dealing with an unprecedented increase in the number of grant applicants and applications due to the massive capacity-building among U.S. research institutions over the past few years. For example, NIH received as many additional new grant applications (8,359) in the last 2 years as there were during the preceding 5-year period (8,302). Essentially, the demand for grants took off just as the NIH budget was landing after years of tremendous growth.

The NIH community must meet these new challenges with adaptive planning that allows us to continue pursuing new discoveries with vigor and vision. We have been planning over a considerable period of time for how best to manage our resources in this period of flattening funding scenarios that followed the extraordinary doubling of the NIH budget from 1998 to 2003. I am confident that the measures NIH has taken will help preserve the great momentum we have witnessed in cancer research. For example, NIH has been proactive in managing these challenges by launching programs for new investigators to maximally preserve their opportunities for funding. In addition, despite a flat budget, our FY 2007 plans call for increasing the number of available new and competing awards by about 3 percent.

As a responsible steward of NIH funds, Congress is appropriately asking for assurances that its investment in medical research is a wise choice. Fortunately, we have a very impressive case to make. Discoveries fueled by NIH support are transforming the practice of medicine. We can now clearly envision an era when the treatment paradigm of medical care will change to become increasingly more predictive, personalized, and preemptive. We will identify disease before symptoms appear, tailor therapy to the individual, and strike disease before it strikes, thus increasing the likelihood that overall costs to society may be reduced.

That is my message to House and Senate committees this year - a message that is proving to be very effective. Legislators are surprised and gratified to learn that the cumulative costs of funding the fight against cancer over the past 30 years total a mere $260 per American, or about $9 per year. The return on that investment has been strong: Mortality rates for cancer have been falling for several years; and NCI has stimulated development of more effective and targeted therapies, increases in early detection and treatment of cancer, and the initiation of truly transformative research.

The public health impact of the cancer community's efforts has been tremendous. It is especially important now to educate the public at the local, regional, and national levels about the critical role the nation's investment in biomedical research is playing in improving the health of Americans.

Great communities are not defined during times of sunny weather, but by their response during the inevitable stormy times. I trust that the cancer community will remain strong in carrying out its vision to transform how we will prevent, detect, or treat cancer, and render optimal cancer care in the future.

Dr. Elias A. Zerhouni
Director, National Institutes of Health