focus on specific subpopulations must be articulated, and the efforts to address the needs of special populations should conform to that rationale. Third, the criteria and procedures used to set research priorities for the general population must be examined with an eye to their adequacy to priority setting for special populations. This section discusses these three issues.


The mission statement of NIH states that its primary aim is research designed "to uncover new knowledge that will lead to better health for everyone." The mission statement of NCI embodies similar institutional goals tailored to its specific disease focus. The ultimate aim of NCI, according to a 1998 NCI report, Priority Setting at the National Cancer Institute (National Cancer Institute, 1998g) is "to prevent or cure cancer." Given the quite general language of the NIH and NCI mandates, a wide array of policy options and research priorities is compatible with fulfillment of their missions. Accordingly, the NCI report emphasizes that priority setting is necessary "because there are more mission-related things that could and should be done than there are resources available to do them'' (National Cancer Institute, 1998g, p. 7).

A three-pronged approach is outlined in NCI's fiscal year 1999 bypass budget:


    Sustain at full measure the proven research programs that have enabled NCI to come this far.


    Seize extraordinary opportunities to further progress made possible by previous research discoveries.


    Create and sustain mechanisms that will enable NCI to rapidly translate findings from the laboratory to practical applications that will benefit everyone.

NCI's approach reveals three especially noteworthy principles relevant to this committee's charge. As indicated in more detail below, these principles themselves offer no definitive guide to priority setting, but they do point the way toward reducing some common misunderstandings that sometimes color the public debates about the relation between NCI's mission and its choice among the many policy options in service of its mission.

First, the central aim of NIH and its institutes, including NCI, is the production of new knowledge about the causes, prevention, and cure of cancer. Both NCI and NIH emphasized the acute need to focus on the production of knowledge that might not otherwise be generated without the support of public agencies. This rationale is often articulated as the

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