In 1992, Congress used an earmark to direct some Pentagon appropriations for breast cancer research. Today, that single spending item has been joined by a host of other medical research programs in the annual defense spending bill. In the past two decades, lawmakers have ordered the Defense Department to spend some $7 billion it didn’t ask for to fight a variety of diseases, most of which have no direct relation to combat.
This Congress has scrapped the formal practice of earmarking — in which individual lawmakers direct money to specific programs — but something called the Congressionally Directed Medical Research Program remains as popular as ever on Capitol Hill. Proposals to add unrequested money to the program rarely trigger opposition from either side of the aisle. Who, after all, is against fighting disease, even in an era of belt-tightening?
Despite this solid support, a tiny cadre of lawmakers backed by congressional auditors and other experts have made the case that these billions of dollars in Pentagon-funded medical research are not being effectively managed to combat the disorders they are intended to fight. Even one of the military’s top medical priorities — treating brain injuries in soldiers — is among the most poorly managed Pentagon research programs, experts say.
And the Defense Department doesn’t want all of this medical research money anyway, because in order to add it to the defense spending bill, members generally have to subtract from other programs to which the military assigns greater value. The funding, which used to be appropriated in response to members’ usually parochial requests for earmarks, are now being added through the more opaque process of “committee adds.”
Laura Peterson, an analyst with Taxpayers for Common Sense, a group that monitors government spending, calls the additional medical research a “zombie earmark.”
“These programs are clearly earmarks and therefore take money away from other necessary Defense Department functions,” says Peterson. “Just because breast cancer or multiple sclerosis are diseases worth fighting doesn’t mean federal funds for research should come out of the Defense Department budget.”
The fact is, though, that gaining bipartisan support to carve a few hundred million dollars out of the $600 billion-plus annual Defense spending bill is easier than obtaining the equivalent amount from the National Institutes of Health’s roughly $40 billion annual allotment. As a consequence, the medical research community, including universities and dozens of interest groups, lobbies heavily to raid the Pentagon budget for these funds for the same reason that Willy Sutton robbed banks: because that’s where the money is.
Little Opposition
Proponents of medical research in the Pentagon budget say it has led to certain advances in the prevention and treatment of diseases. And no one in Congress is opposed to the general notion of funding such work.
Indeed, only a few lawmakers — such as Republican Sens. John McCain of Arizona and Tom Coburn of Oklahoma — have opposed diverting defense funds for medical research.
Defense Secretary Leon E. Panetta has criticized Congress for altering the Pentagon budget request. “Every dollar that is added will have to be offset by cuts in national security,” he said at a news conference in May.
Asked whether the medical research programs are the sort of spending Panetta was talking about, a Pentagon spokeswoman, Lt. Col. Elizabeth Robbins said: “The Department of Defense is concerned about the addition of any funding not included in the president’s budget request.” She added that the extra provisions “divert resources from critical defense programs and priorities and limit the secretary’s flexibility to manage the department efficiently.”
Moreover, the spending has not been well managed, according to congressional auditors and other experts, who say defense officials have failed to properly account for funds and to sufficiently coordinate their work with other federal efforts in order to avoid duplication. And they haven’t fully tracked the effectiveness of treatments they are researching, the critics say.
The Government Accountability Office, in a February report, cited duplicative medical research as one of the 51 federal programs ripest for savings. The Pentagon, the Department of Veterans Affairs and NIH “each lack comprehensive information on the health research funded by the other agencies, which limits their ability to identify potential areas of duplication in the areas of health research they fund,” the auditors wrote.
Coburn says it’s “crazy” to have duplicate programs. “I think there’s a good place for medical research to occur at the Pentagon, but it should be related to the military, whether it be brain injuries, whether it be trauma, blood loss, volumetric shock, whatever it is,” he says. “Now we’re doing prostate cancer at the Pentagon. It’s just nuts.”
The inefficiency and ineffectiveness of some of the spending is most galling to critics in the area of post-traumatic stress disorder (PTSD) and traumatic brain injury, which are often called the signature wounds of the wars in Iraq and Afghanistan.
In January, the GAO audited the brain research programs and found that the Pentagon could not accurately account for funds spent and therefore was unable to correctly report them to Congress. What’s more, the auditors said, no single Pentagon office could list the various research programs in this area.
The GAO reported that, despite the significance of PTSD and traumatic brain injuries and the more than $2.7 billion Congress appropriated for research, the Defense Department “is not currently in a position to readily report in a reliable manner on how funds are being used to provide benefits to servicemembers.”
“Without an entity to coordinate these activities,” GAO wrote, “DoD will remain hampered in its efforts to ensure that resources are used effectively to meet goals.”
Appropriators are aware of the auditors’ findings. In a May report accompanying the House’s defense spending bill, they expressed “dismay” about the oversight problems and urged the Pentagon to pay heed to the auditors’ recommendations.
“There’s always criticism of programs,” says Rep. Norm Dicks of Washington, the Democratic appropriator with the most seniority. “I have felt this is a good program. I try to monitor it. We want to make sure the money’s being spent wisely and effectively.”
Absence of Measuring
Just this month came confirmation of GAO’s conclusions, from a highly qualified source. The Institute of Medicine of the National Academies found that the Pentagon and the Department of Veterans Affairs aren’t measuring the effectiveness of their spending on PTSD, one of the most widespread invisible war wounds.
“DoD and VA offer many programs for PTSD, but treatment isn’t reaching everyone who needs it, and the departments aren’t tracking which treatments are being used or evaluating how well they work in the long term,” writes Sandro Galea, who chaired the panel that did the new study and runs the epidemiology department at Columbia University. “In addition, DoD has no information on the effectiveness of its programs to prevent PTSD.”
The fiscal 2013 defense spending measure approved in May by the House Appropriations Committee contained fully $545 million more than requested for Defense Health Program research and development, on top of the $673 million the administration had sought.
Despite the appropriators’ stated worries about management of the brain injury research, they nonetheless added $125 million for it. Two months later, as the full House debated the bill, it adopted amendments adding at least $35 million more for research into several medical problems — including $10 million for brain injuries.
When the Senate Appropriations Committee marks up its defense spending bill this week, it too is expected to add funding.
The extra spending is driven in no small measure by the influential lobbying efforts of the medical and university establishments. Dozens of groups that benefit from the programs band together each year and write appropriators to defend it. The signatories on one 2011 letter covered groups literally from A to Z: from the American Academy of Dermatology Association to ZERO — The Project to End Prostate Cancer.
“These research programs target diseases that impact directly the welfare of the American military, their families and the public,” the groups wrote to the leaders of the House Defense Appropriations Subcommittee.
During the debate on the defense bill for fiscal 2013, it became clear that the pitch had been successful. Members on both sides of the aisle said they saw no reason to discontinue spending on these programs.
“We’ve always been supportive of it and will continue to,” said Republican Jack Kingston of Georgia, referring to cancer research money in the Pentagon’s budget.
“We cannot do enough on this issue, because this is going to have a lifetime effect on these people,” added Dicks.
- John M. Donnelly
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