Demanding disease dollars: How activism and institutions shape medical research funding for breast and prostate cancer.

摘要

Breast and prostate cancer affect and kill approximately the same numbers of women and men, however breast cancer receives more than double the federal funding for medical research than prostate cancer. This dissertation explores this funding discrepancy, and the political processes that underlie it. I ask how breast cancer activists in the early 1990s—a group without financial resources, expensive lobbyists or access to power—were able to gain funding increases while prostate cancer activists in the mid-1990s—a group with monetary resources, a professional organization and significant connections on Capitol Hill—met with only modest levels of success. Additionally, I examine how breast cancer activists were able to establish and maintain a massive breast cancer research program at the Department of Defense while the DoD's Prostate Cancer Research Program was established four years later and has consistently received less funding despite the larger proportion of men, both active duty and retired, who make use of military health systems. To unravel these questions I look at the groups demanding funding increases and the targets of their demands, members of Congress. Central to understanding how a group achieves outcomes is the interaction between groups and congressmembers and the fit between a group's strategies and factors that influence these legislators. I find that grassroots activism is vital to influencing Congress, and the origins of breast cancer activism and the organizational form that developed among breast cancer activists allowed them to more effectively pursue a strong, well-organized, consistent, informative, and persuasive grassroots lobbying campaign.