NIH DIRECTOR

Secretary SULLIVAN. It is Dr. William Raub who is the Acting Director.

Senator BUMPERS. Are you on the committee to select the successor to Dr. Wyngaarden?

Secretary SULLIVAN. I am not on the search committee which I appointed, and will be making their recommendations to me.

Senator PUMPERS. Have you prescribed a litmus test that the new Director will have to pass, for example, on the abortion issue? Secretary SULLIVAN. No; Senator Bumpers, I did not. The search committee has a number of distinguished people from the private sector: Harold Amos, Ph.D., Harvard Medical School; Theodore Cooper, M.D., Upjohn Co.; James F. Dickson III, M.D., Boston University; James R. Gavin III, M.D., University of Oklahoma; Frederick C. Robbins, M.D., Case Western University; Richard S. Ross, M.D., Johns Hopkins University; Virginia V. Weldon, M.D., Monsanto Co., and others. I indicated to them that the primary criteria for the new director at NIH would be scientific excellence and administrative capabilities.

I further indicated to them that I had discussed this matter with the President and his chief of staff, and they support me in that position. I also made a public address on that issue in November of last year to the Association of American Medical Colleges where I related to them the fact that it was unfortunate that a low level individual in the White House personnel office, without my knowledge or concurrence, had made such an inquiry concerning abortion to an individual whose name had been submitted.

Senator BUMPERS. A person I would like to have seen head up NIH.

Secretary SULLIVAN. We had not submitted any names to the White House at that time.

Senator BUMPERS. You are sure that a litmus test on particular issues will not be given any applicants for the NIH Director's job? Secretary SULLIVAN. I cannot guarantee that, Senator Bumpers. Clearly this happened in an instance I had no knowledge or control over. I can guarantee you that this is not the primary criterion for that individual, and the statement that I gave to the Association of American Medical Colleges was reviewed by the White House, so I was speaking with their concurrence.

Senator BUMPERS. I accept that, and I thank you.

Senator HARKIN. Senator, are you through on this line of questioning?

Senator BUMPERS. No; go ahead if you like.

Senator HARKIN. I was going to get into that later on, but as long as you are on it, we might as well finish it.

You repeatedly say, Dr. Sullivan, that it is not the primary criterion. Is it even a criterion?

Secretary SULLIVAN. My position on that, Mr. Chairman, is those issues are not appropriate for the consideration of the Director of our premier biomedical research enterprise. Those decisions are more appropriately made at a policy level beyond that of the Director of NIH and, therefore, that question of abortion and other similar questions are not governing questions.

On any range of issues, we want to be sure that whoever is chosen, is someone who indeed can be an effective spokesman for our biomedical research. We would look at that individual's compatibility with our overall programs. On the issue of abortion is not criterion for the selection.

Senator HARKIN. Other matters you said relating to it, would that include fetal tissue research?

Secretary SULLIVAN. No; what I am referring to is we have a whole range of things that we are constantly dealing with such as how do we allocate the resources in our budget. There are always tensions and differences of perspective. What we need to have is someone who understands first of all not only the demands and needs of our biomedical research enterprise, but also how to work in a system where there are many competing demands.

Senator HARKIN. But the attitude of a prospective individual to be head of NIH, the attitude of that person toward fetal tissue research, you say is also not a criterion?

Secretary SULLIVAN. That is correct.

Senator HARKIN. Thank you, Dr. Sullivan.

Senator BUMPERS. Thank you, Mr. Chairman.

Dr. Sullivan, Stalin demanded philosophical and ideological tests of scientists and when the war started, he killed off all his best scientists.

Of course, I am not suggesting a parallel case here, but I am offended that candidates for a job which is probably the premier biomedical job in the country would be asked to pass a test on abortion.

I am not an ideolog on this issue, but I hope you will do everything you can to make certain that an abortion litmus test is not the test for this job. I may be dead wrong, but I frankly think that was one of the things that caused Dr. Wyngaarden to leave, and I thought he was doing a superb job.

On more mundane matters, have you seen the article in the New York Times Sunday magazine on the impact of drinking on the fetus-I believe the research was done at Emory University?

FETAL ALCOHOL SYNDROME

Secretary SULLIVAN. I did not see that particular article, Senator Bumpers, but I am very familiar with the problem of fetal alcohol syndrome and the resulting problems.

Senator BUMPERS. Of course we have all seen these horror segments on the news about crack babies, and it is a horrible thing. Of course the recent film from Romania of dozens of babies who have AIDS was heartbreaking.

Of course, we should be concerned about crack babies, but this article indicates that 2.7 percent of all the babies born in this country have learning disabilities as a result of fetal alcohol syndrome. I am just wondering if your Department, CDC, or any other agency, is trying to disseminate information on preventing fetal alcohol syndrome?

Here is a place where we are more likely to have great success with a limited amount of money. I would appreciate an update on

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what your Department is doing to address the problem of fetal alcohol syndrome.

Secretary SULLIVAN. Senator Bumpers, we are not only fully aware of the problem of fetal alcohol syndrome and other problems of prematurity, resulting from drinking but indeed we have a number of programs to address that problem, primarily at our Alcohol, Drug Abuse, and Mental Health Administration. The National Institute of Alcohol Abuse, is entirely committed to the prcblems of alcoholism in our society. We have a lot of research underway.

For example, our research is showing increasingly genetic influences in terms of predisposition to alcohol abuse, learning disabilities that you alluded to, low birth weight, et cetera. We also have a number of public education programs concerning alcohol abuse. Many of the facilities that we fund around the country deal with drugs and problems of alcohol abuse. We work with employers to support their programs for rehabilitation of individuals with alcohol abuse as well.

Senator BUMPERS. Dr. Sullivan, the most recent high school senior drug abuse survey gave us some comfort that drug use among high school seniors has been declining. It is not a big decline, but as I say, we can take some comfort in the fact that among high school seniors the use of drugs has been declining.

But the same report also shows a figure that was startling to me; that was that 35 percent of the high school seniors of this country, 17-year-old kids, said they had had five drinks or more in a row within the preceding 2 weeks.

Now, that would indicate that we have got a big alcohol problem among young people in the country, would you not think?

Secretary SULLIVAN. I am very concerned about problems of excess alcohol ingestion and, in fact, met approximately 4 weeks ago at the White House with a number of private organizations that are concerned with alcohol abuse and all of the related problems. Part of our health promotion program is to warn our citizens about the problems of drinking-in terms of impairing health, impairing ability to drive motor vehicles or to use machinery in factories, et cetera.

RECRUITING SENIOR SCIENTISTS

Senator BUMPERS. Dr. Sullivan, I am sure you are aware of the problems we have at NIH in recruiting senior scientists. I spent a day at NIH last year, and they told me that we had not recruited a single senior scientist in the last 3 years.

Dr. Wyngaarden suggested that was mostly because of the salary schedule. We apparently have been able to recruit senior scientists from within the ranks of NIH scientists. But salaries for senior scientists are apparently one of the biggest problems at NIH.

Secretary SULLIVAN. That is a significant problem, Senator Bumpers. We have not recruited a senior scientist in 10 years at NIH. We have a premier biomedical research institution, that has made many contributions over the years, that is in danger of being eroded if we do not address many of the problems there. Let me give one quick example of what I mean.

When I was a medical student in the mid-1950's in Boston, I took care of patients with paralytic polio in the epidemics in the summers of 1956 and 1957. Those individuals were in iron lungs. Changing their bed linen was a labor-intensive effort; we had to take them out of the iron lungs, assisting them to breathe, required the help of nurses, residents, and students.

At that same time Dr. Thomas Endes, a microbiologist at the Harvard Medical School was working in his laboratory with a grant of some $53,000 from the National Institutes of Health to find a way to grow the polio virus in the laboratory. He found a way to do this on monkey kidney slices. He received the Nobel Prize for that because that discovery then enabled Jonas Salk and Albert Sabin to develop the polio vaccine. Polio is almost now banished from the American scene.

But if you project from the mid-1950's to now what we would be paying in health care costs to maintain people in iron lungs; orthopedic and surgical corrective procedures, to try and correct withered limbs, to pay for wheelchairs, et cetera-that is just one example of the return that we have from our investment in biomedical research.

I am very concerned about salaries and other things in the environment at NIH that we need to address. I appointed a committee to help advise me on ways to make the NIH Director's position more attractive. Salary is important, no question. But there are some other reasons as well, and some of those reasons include the actions of the Congress.

Congress over the years has eroded the authority of the NIH Director by creating Institutes. We have said this is counterproductive, despite those recommendations, this has happened. Those Institutes have been created without increases in the number of FTE's at NIH, so it weakens the other Institutes when we bleed internally. When we move people from existing Institutes, we increase administrative costs, and it also erodes the authority of the Director when that individual in trying to develop a comprehensive research budget and policy has people running around him directly here to the Congress and then having mandates put in the budget for one of the specific Institutes.

I will be coming back to you and other Members of Congress once we have reviewed the advice from our committees with a whole range of things for which we will need your help on. Salary is one. That is very critical because we do have a three to fourfold interest in income for a scientist at NIH versus our universities or the private sector. But there is a lot more than that, and we certainly look forward to working with you on that.

Senator HARKIN. If you could yield on that.

Senator BUMPERS. I would be happy to.

Senator HARKIN. I cannot let this moment escape, Dr. Sullivan. I understand your strong feelings about Congress setting up institutes, but it comes to my attention that last year you came down and wanted us to set up a human genome center, a separate center, which we did. That cuts both ways.

Secretary SULLIVAN. Senator Harkin, that is a center. That is not an institute.

What that is, is a position-

Senator HARKIN. But it has the same administrative setup that an institute has.

Senator BUMPERS. Dr. Sullivan, I am not sure that even needs an answer. I think the point is made that there is plenty of blame to go around. That is what the chairman is saying.

I would ask you who would you blame, for example, for a budget that asks for five airplanes that cost almost as much as all the Institutes of Health combined? Where do you put the blame on that? Secretary SULLIVAN. Well, let us let this one drop, OK.

Senator HARKIN. Could I bring up one other point on NIH?

I understand we have got to get the salaries up for the scientists, for the Director.

But, Senator Bumpers, I want you to also focus, if you could, on the need to get the salaries up for some of the postdoctoral people that come there to do research. These are the bright young scientists. They are interested in a certain area. A lot of them have been in school 8, 10, 11 years. They are in their thirties. They are probably married. They probably have one or two kids. They have all these school bills, and you know what they are paying right now at NIH for postdoctoral research? Correct me if I am wrong, but it is around $26,000.

Secretary SULLIVAN. That is correct.

Senator HARKIN. How are you going to live in this area on $26,000 a year? There is no way you can do it. So, we have got to focus on that, too. These are bright young people that want to come in and dedicate a few years of their lives to researching a certain subject, a certain interest that they have and for that much money, we cannot get them.

Secretary SULLIVAN. I agree with you, Senator Harkin.

Let me just cite one other startling thing that I learned a few months ago, and that is that the visiting scientists who come and spend 1 year or 6 months or so on the campus of NIH, one-third of these are foreign scientists. We are training other nations' scientific leadership, and one of the reasons for that is indeed the salary structure; we have made it unattractive and almost impossible for some of our scientists to pursue a scientific career. I share with you that real concern, and I look forward to working with you as we try to address this issue.

NATIONAL HEALTH SERVICE CORPS

Senator BUMPERS. Dr. Sullivan, I want to compliment you on recommending the funds for 750 student scholarships for the National Health Service Corps. We have very deep pockets of poverty in my State and in Mississippi and Louisiana, on both sides of the Mississippi River, in an area we call the delta. An area, by the way, where the per capita income is less than it is in Czechoslovakia. If it were not for National Health Service Corps doctors, we would have no health care in some of the most pervasively poor areas of America.

So I really applaud you for trying to resurrect a program which has great merit.

Now, Mr. Chairman, I just have two quick things.