Setting Research Priorities

There has been much polemic about affluence, consumption, and the global environment. For some observers, "consumption" is at the root of global environmental threats: wealthy individuals and societies use far too much of the earth's resource base and should scale back their appetites to preserve the environment for future generations and allow a decent life for the rest of the world. Other observers see affluence as the way to escape environmental threats: economic development increases public pressure for environmental protection and makes capital available for environmentally benign technologies. The arguments are fed by conflicting beliefs, values, hopes, and fearsâ€"but surprisingly little scientific analysis. This book demonstrates that the relationship of consumption to the environment needs careful analysis by environmental and social scientists and conveys some of the excitement of treating the issue scientifically. It poses the key empirical questions: Which kinds of consumption are environmentally significant? Which actors are responsible for that consumption? What forces cause or explain environmentally significant consumption? How can it be changed? The book presents studies that open up important issues for empirical study: Are there any signs of saturation in the demand for travel in wealthy countries? What is the relationship between environmental consumption and human well-being? To what extent do people in developing countries emulate American consumption styles? The book also suggests broad strategies that scientists and research sponsors can use to better inform future debates about the environment, development, and consumption.

The National Institutes of Health (NIH) is the single largest funder of health research in the United States, and research it has supported has been pivotal to the explosion of biomedical knowledge over the past century. As NIH's success has grown, so has pressure from advocacy groups and other members of the public to devote more spending to their health concerns. In response to a request from Congress, this IOM study reviewed NIH's research priority-setting process and made recommendations for possible improvement. The committee considered the: Factors and criteria used by NIH to make funding allocations. Process by which the funding decisions are made. Mechanisms for public input. Impact of congressional statutory directives on funding decisions. Among other recommendations, the book recommends that NIH seek broader public input on decisions about how to spend its nearly $14 billion budget; it also urged the agency to create new Offices of Public Liaison in the Office of the Director and in each of the 21 research institutes to allow interested people to formally take part in the process.

This book examines methods for selecting topics and setting priorities for clinical practice guideline development and implementation. Clinical practice guidelines are "systematically defined statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." In its assessment of processes for setting priorities, the committee considers the principles of consistency with the organization's mission, implementation feasibility, efficiency, utility of the results to the organization, and openness and defensibilityâ€"a principle that is especially important to public agencies. The volume also examines the implications of health care restructuring for priority setting and topic selection, including the link between national and local approaches to guidelines development.

How do we effectively teach children from homes in which a language other than English is spoken? In Improving Schooling for Language-Minority Children, a committee of experts focuses on this central question, striving toward the construction of a strong and credible knowledge base to inform the activities of those who educate children as well as those who fund and conduct research. The book reviews a broad range of studiesâ€"from basic ones on language, literacy, and learning to others in educational settings. The committee proposes a research agenda that responds to issues of policy and practice yet maintains scientific integrity. This comprehensive volume provides perspective on the history of bilingual education in the United States; summarizes relevant research on development of a second language, literacy, and content knowledge; reviews past evaluation studies; explores what we know about effective schools and classrooms for these children; examines research on the education of teachers of culturally and linguistically diverse students; critically reviews the system for the collection of education statistics as it relates to this student population; and recommends changes in the infrastructure that supports research on these students.

Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. In today's healthcare system, patients, physicians, clinicians and family caregivers often lack the sufficient scientific data and evidence they need to determine the best course of treatment for the patients' medical conditions. Initial National Priorities for Comparative Effectiveness Research(CER) is designed to fill this knowledge gap by assisting patients and healthcare providers across diverse settings in making more informed decisions. In this 2009 report, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization establishes a working definition of CER, develops a priority list of research topics, and identifies the necessary requirements to support a robust and sustainable CER enterprise. As part of the 2009 American Recovery and Reinvestment Act, Congress appropriated $1.1 billion in federal support of CER, reflecting legislators' belief that better decisions about the use of health care could improve the public's health and reduce the cost of care. The Committee on Comparative Effectiveness Research Prioritization was successful in preparing a list 100 top priority CER topics and 10 recommendations for best practices in the field.

Cardiovascular diseases (CVD) are increasing in epidemic proportions in developing countries. CVD already accounts for almost 10 percent of the developing world's burden of disease and is likely to become the developing world's leading cause of death. There is reason for hope, however, given that huge potential exists for applying R&D to control this emerging epidemic--both in creating powerful new interventions such as vaccines and dietary supplements and in guiding behavior. In addition, a considerable body of evidence suggests that current risk-factor prevention programs and low-cost case management of CVD offer feasible, cost-effective ways to reduce CVD mortality and disability in developing country populations. Large-scale CVD control efforts are lacking, however, and thus governments and individuals are left to make choices about health and health care services without the benefit of appropriate knowledge. This report was designed to promote a policy dialogue on CVD based on informed knowledge of R&D opportunities that offer effective, affordable, and widely applicable responses in developing countries. The report examines (a) the emerging burden of CVD in developing countries, (b) the future worldwide burden of CVD, (c) current prevention and treatment of CVD in developing countries, (d) R&D to support CVD control, (e) opportunities and priorities for R&D, and the need for institutional arrangements for collaboration in facing the epidemic.

The medical research landscape in the United States is supported by a variety of organizations that spend billions of dollars in government and private funds each year to seek answers to complex medical and public health problems. The largest government funder is the National Institutes of Health (NIH), followed by the Department of Defense (DoD). Almost half of DoD's medical research funding is administered by the Congressionally Directed Medical Research Programs (CDMRP). The mission of CDMRP is to foster innovative approaches to medical research in response to the needs of its stakeholdersâ€"the U.S. military, their families, the American public, and Congress. CDMRP funds medical research to be performed by other government and nongovernmental organizations, but it does not conduct research itself. The major focus of CDMRP funded research is the improved prevention, diagnosis, and treatment of diseases, injuries, or conditions that affect service members and their families, and the general public. The hallmarks of CDMRP include reviewing applications for research funding using a two-tiered review process, and involving consumers throughout the process. Evaluation of the Congressionally Directed Medical Research Programs Review Process evaluates the CDMRP two-tiered peer review process, its coordination of research priorities with NIH and the Department of Veterans Affairs, and provides recommendations on how the process for reviewing and selecting studies can be improved.