As in physics and chemistry, Americans have dominated the Nobel Prize for physiology or medicine since World War II. The National Institutes of Health, the focal point for biomedical research in the United States, has played a key role in this achievement. Consisting of 24 separate institutes, the NIH occupies 75 buildings on more than 120 hectares in Bethesda, Maryland. Its budget in 2000 was almost $23 thousand million.

 

The goal of NIH research is knowledge that helps prevent, detect, diagnose, and treat disease and disability -- everything from the rarest genetic disorder to the common cold. At any given time, grants from the NIH support the research of about 35,000 principal investigators, working in every U.S. state and several foreign countries. Among these grantees have been 91 Nobel Prize-winners. Five Nobelists have made their prize-winning discoveries in NIH laboratories.

 

NIH research has helped make possible numerous medical achievements. For example, mortality from heart disease, the number-one killer in the United States, dropped 41 percent between 1971 and 1991. The death rate for strokes decreased by 59 percent during the same period. Between 1991 and 1995, the cancer death rate fell by nearly 3 percent, the first sustained decline since national record-keeping began in the 1930s. And today more than 70 percent of children who get cancer are cured.

 

With the help of the NIH, molecular genetics and genomics research have revolutionized biomedical science. Building on initial work dating from the 1980s and 1990s, international research teams have constructed a map of the human genome. The genome is defined as all the DNA in the human body, and it was mapped to 99.99 percent accuracy in a project completed in 2003 involving hundreds of scientists at 20 sequencing centers in China, France, Germany, Great Britain, Japan, and the United States.

 

Scientists will use this new knowledge to develop genetic tests for susceptibility to diseases such as colon, breast, and other cancers and to the eventual development of preventive drug treatments.

 

Research conducted by universities, hospitals, and corporations also contributes to improvement in diagnosis and treatment of disease. NIH funded the basic research on Acquired Immune Deficiency Syndrome (AIDS), for example, but many of the drugs used to treat the disease have emerged from the laboratories of the American pharmaceutical industry; those drugs are being tested in research centers across the country.

 

One type of drug that has shown promise in treating the AIDS virus is the protease inhibitor. After several years of laboratory testing, protease inhibitors were first given to patients in the United States in 1994. One of the first tests (on a group of 20 volunteers) showed that not only did the drug make the amount of virus in the patients' blood almost disappear, but that their immune systems rebounded faster than anyone had thought possible.

 

Doctors have combined protease inhibitors with other drugs in "combination therapy." While the results are encouraging, combination therapy is not a cure, and, so far, it works only in the blood; it does not reach into the other parts of the body -- the brain, lymph nodes, spinal fluid, and male testes -- where the virus hides. Scientists continue to experiment with combination therapy and other ways to treat the disease, while they search for the ultimate solution -- a vaccine against it.