. "4 Evaluation of Priority Setting and Programs of Research on Ethnic Minority and Medically Underserved Populations at the National Institutes of Health." The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. Washington, DC: The National Academies Press, 1999.
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differential health burdens exist therefore warrants vigilant monitoring of differentials within subpopulations and attention to the need for research on the causes and mitigation of those differences as a supplement to the other parts of the research portfolio.
Moreover, a predictable consequence of the heavy reliance on researcher-initiated proposals is the increased likelihood that important questions regarding disease among those most heavily burdened will go unasked, especially if environmental and behavioral factors play an important mediating role and the incentives of the marketplace make their study less likely. Accordingly, various strategies designed to direct, motivate, and focus researcher imagination may be necessary as a supplement to the investigator-initiated approach if gaps in scientific knowledge contributing to differential health burdens are to be taken seriously.
Although NCI has provided the committee with many additional documents outlining its past and ongoing initiatives for special populations and its plans for the expansion of its Division of Cancer Control and Population Sciences, some unanswered questions remain. In oral testimony before the committee, Director Klausner emphasized the importance of crosscutting research and the fact that the differential cancer burdens experienced by some subpopulations will derive benefits from the knowledge gained from research on cancer generally. According to Klausner, much of the research not attributed to budgetary codes specific to research on cancer among special populations also produces secondary benefits for special populations, and thus, data regarding special initiatives alone fail to provide a full accounting of the level of NCI's commitment to meeting the health needs of those populations. The committee acknowledges the importance of these ancillary contributions that some critics may fail to appreciate.
However, the committee believes that Klausner's remarks emphasizing the secondary benefits derived from crosscutting research leave the status of NCI's commitment to special population research initiatives somewhat uncertain. In supplementary written testimony provided to the committee by Barbara Rimer in response to committee questioning (Rimer, communication with the study committee, 1998), NCI indicated that it intends to pursue both the traditional investigator-initiated approaches and RFAs targeted to special populations. In addition, Rimer shared budget proposals for future initiatives affecting many of the groups that NCI defines as special populations.
The committee applauds Rimer's statement of commitment to the continuation and expansion of such initiatives. However, important unresolved issues of both the process and the criteria used for priority setting for research among special populations remain. For example, the future role of the Director of Special Populations remains unclear. Klausner has