Pediatric Research. National Institutes of Health support in the 'steady-state' decade, 1983-1993.
To examine the trend in the US Public Health Service's National Institutes of Health (NIH) funding for pediatric research over the last 10 years in terms of dollars expended, grants awarded to pediatrics departments vs other medical school departments, NIH Clinical Research Center support, and the distribution of NIH grants to all medical schools and children's hospitals in the United States. Statistical information from the Division of Research Resources of the NIH, the NIH Clinical Research Center office, and the Society for Pediatric Research for the fiscal year 1982-1983 was compared with fiscal year 1992-1993. Inflation-adjusted dollar calculations were used. All numbers reflect total costs (direct plus indirect costs). Research grant support to medical school departments has been stable, increasing only 1% per year in inflation-adjusted dollars to a total of $3.051 billion; while the total number of grants has decreased 12% to 12785 awards. Support for pediatric research increased 91% in inflation-adjusted dollars (to $164 million) during this period, and the number of pediatric research grants increased from 390 to 608 (up 56%). However, the nation's 76 clinical research centers (CRCs) show pediatric clinical research is diminishing. Support for such research has fallen a dramatic 55% in 10 years, despite $5.4 million for pediatric acquired immunodeficiency syndrome (AIDS) clinical trials. There are more pediatric researchers since 1983 (1327-1857), increasing dramatically the number of unfunded pediatric scientists. Disparity of research funding continues between the top research-oriented medical schools (15 of the 126 departments receive 51% of the awards), compared with 72 medical school departments that have 0, 1, or 2 pediatric research grants. Most medical students in the United States will never encounter an NIH-funded pediatric researcher during their medical school training. Pediatric research has increased its absolute and relative NIH grant support in the last 10 years to a greater degree than all other clinical departments except for psychiatry, neurology, and anesthesiology. The distribution of grants favors a small number of departments and children's hospitals. Clinical pediatric research supported by the NIH has fallen dramatically. In the era of stable NIH funding, pediatric investigators must develop other sources (private funding and industry) for expanding their research activities.