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Answer. Progress has been made in addressing the shortfall of trained nurses. The aggregate supply of registered nurses is at an all-time high and is projected to increase until about 2005. In recent years enrollments in schools of nursing have increased significantly. Preliminary data from the National League for Nursing indicates the enrollments in the fall of 1990 totalled about 230,000, a 12 percent increase over the number enrolled in the fall of 1989. Preliminary estimates of graduations also showed significant increases. These data, along with the findings in the March 1988 National Sample Survey of Registered Nurses, suggest that the nurse supply will remain at fairly high levels, at least in the near future. However, by the year 2010, the picture changes markedly. Significant declines are noted for the supply of registered nurses at a time when the need for nurses is exacerbated by the increase in the elderly and vulnerable populations.

The Secretary's Commission on Nursing assessed the cause of the nursing shortage as stemming from the increases in employer demand which could not be satisfied by the available supply. The latest available data from surveys of employers in various fields suggested a continuing high level of budgeted vacant positions. Based on these data there may currently be about 126,000 - 158,000 additional full-time equivalent registered nurses needed.

Furthermore, a HRSA study of the need for nurse advanced trained specialties made at the request of the Senate Appropriations committee in 1988 indicated that the need for nurses with master's degrees would be more than 4 times that of the full-time equivalent supply in 1988.

Question. In your professional judgment, should the federal government continue to support nurse training programs?

Answer. This is not my area of expertise. It may be more appropriate to ask this question of the Director of HRSA's Division of Nursing. Nonetheless, through my work with the Commission, it is my professional judgment that there is a continuing need for the support of nurse training programs and for the support of the data collection efforts to monitor the nursing shortage.




Senator HARKIN. Dr. Watson, it is good to see you here again today and welcome. I am sorry for all the delays we have had today.

I have been following the center's work with much interest. As you know, I am one of the more enthusiastic supporters of the human genome project.

I see that your request this year is for $110.5 million, which is an increase of approximately $23 million over the 1991 appropriations.

Would you briefly describe what initiatives you are planning to undertake in 1992 and the overall status of the effort to map and sequence the human genome?

Dr. WATSON. Mr. Chairman, I am delighted to have this second opportunity to share with you and members of the committee my enthusiasm for what I believe is one of the most exciting and significant biomedical research undertakings of this century. With the strong support from the Congress and from the Department of Health and Human Services, the human genome project officially began on October 1 of last year.

Very simply the goals of the human genome project are to develop biological maps for each human chromosome and then to read the genetic text written in the chemical sequence of human DNA. Why should we do this? We want to do it because this is the way that we can come to a much deeper and complete understanding of all the many diseases of human beings to which genetic predispositions contribute. We believe there are many thousands of genes which affect human health in very significant ways.

I have been very pleased over this past year with a number of developments. Because of the strong support we received from Congress and from the administration, we have been able to attract a very strong staff of people who are helping administer these funds, as well as a group of scientific advisors who are really first-class. So, I think the people who are managing the program are really as fine as you can find in our country. That they have joined in is due to, I think, the excitement they have and the fact that sufficient money has been appropriated to let the project get started in a big way as distinct from a small way.

We want to complete the project in roughly 15 years, and we believe we can do this within a budget of $3 billion. That would mean roughly $200 million per year. We are still building up to a sort of steady state, and that is why the increase of 26 percent, which is in this budget, is necessary for us to maintain the momentum of the program.

Now, as far as significant advances, I think we were asked las year by Congress to look over our budget and to say are we really going to meet the $3 billion figure. So, we have presented to Con gress a reevaluation of the program, and it really falls into two parts.

The first is looking at the mapping problem. Here there has been a series of technological developments which really ensure that the mapping can be done for approximately a $500 million sum. So, we are very confident that that can be done. And this will be very im portant. This is the part of the project which will directly lead dis ease gene hunters to that section of the chromosome where they can home in on their gene. It was knowing the map position which let Francis Collins find the cystic fibrosis gene. You have to know the map position. That is why we have concentrated on maps and now we can make them. Because we know how to make them, we have created a number of specific human genome research centers whose function is to make these maps and get them out to the medical researcher. We think this will really permit a much larger number of people to join in the effort to find disease genes.

The second effort we are moving on is the whole question of actu ally working out the exact messages, what we call DNA sequenc ing. Currently, sequencing costs roughly 10 times more than we believe it should, and so a great deal of our emphasis is placed on trying to develop new technologies which will reduce the costs. Over the next 5 years we think we can achieve this reduction but, of course, until we do, I cannot say we have accomplished our goal. We have put out a number of grants with the aim of sequencing roughly 1 million base pairs per year. Now, there are 3 billion of them, and we want to get people up to the point where 1 billion base pairs does not seem like a big effort. A lot of that will be done by machines, and the machines that conventional wisdom said aren't that good really are good. We have been encouraged over the past year that a machine-I am happy to say it is an American machine-probably can do much of the job.

Now, the last thing I want to mention is that we are very pleased to have set up our ELSI program-that's the ethical, legal, and social implications program. Due to the throws of the genetic dice, some people have a better opportunity for living a fuller life than others, and we are very concerned that this new genetic knowledge does not lead to a form of a genetic underclass which will not only get a bad throw of the genetic dice, but then be treated worse than other people by society as a whole.

Senator HARKIN. I'm sorry. I want to understand what you just said, Dr. Watson.

Dr. WATSON. When you are born

Senator HARKIN. Yes.

Dr. WATSON [continuing]. The exact genes you get are one-half your mother's genes and one-half your father's genes. Now, as a result, children in a given family don't always look the same, they are very different at times. Sometimes they can look quite similar, sometimes very different. When you make a gene, the copying proc ess isn't always perfect. It is largely perfect, and that is, of course, why we can exist. But occasionally it goes wrong and you get a gene such as is responsible for muscular dystrophy. The gene isn't

copied correctly. So, some people are going to inherit faulty genes, and faulty genes will always be here because they arise from mistakes in DNA replication.

Now, muscular dystrophy tends to occur in boys, and it depends which of the two chromosomes from your mother you inherit. You can get a good one or you can get a bad one. So, that is why I say there are some people who are victims of unjust throws of the genetic dice. It is not their parents' fault. It's not their fault, but they've got it. What we have to do is develop ways to treat these people compassionately, both in trying to cure their diseases and in trying to take care of the disabilities which they may have to live with throughout their lives.

So, that is really why we have to have a strong ethics program. When I took over, I said we should spend 3 percent of our money on ethics. In fiscal year 1991, we hope to spend 4 percent and in fiscal year 1992, 5 percent. This will be a growing program. And, of course, the disabilities law which you have helped bring into existence is one which can protect, in part, people who are victims of their genetic heritage. So, we view this ethics program as important as any other aspect of our program. It cannot precede the program. It has to go hand in hand with it because often the exact ethical issues you will face you will only know when you see your bad gene. You will know really what dilemmas it creates. So, they have to go hand in hand. We have an excellent advisory committee on these issues. We have a very strong person, Dr. Eric Juengst, running it in our office, and it is perhaps going to be our most visible component because that is what the general public wants to know, how this is going to influence their lives.


So with that, I will say that the fiscal year 1992 request for the National Center for the Human Genome Research is $110 million this year.

Mr. Chairman, I will be pleased to answer your questions. [The statement follows:]

human diseases.


Mr. Chairman, I am delighted to have this second opportunity to share with you and the members of the Committee my enthusiasm for what I believe is one of the most exciting and significant biomedical research undertakings of this century. With strong support from the Congress and the Department of Health and Human Services, the Human Genome Project officially began work on its goals for the first five years on October 1, 1990. I am pleased to describe to you today the accomplishments we have already achieved as well as the new initiatives the National Center for Human Genome Research (NCHGR) has laid out to reach its goals as rapidly as possible. these goals, the sooner we will get on with the business of truly understanding the complex contributions our genes make to so many, trágic

Indeed, the faster we accomplish

Very simply, the goals of the Human Genome Project are to develop biological maps for each human chromosome and to read the genetic text written in the chemical sequence, or letters, of human DNA. DNA is the substance that carries genetic information contained in the chromosomes of all plants and animals.

Why should we do this? Because we believe it is the only way we will make swift progress toward understanding the thousands of human diseases caused by malfunctioning genes--diseases like Huntington's, Alzheimer's, birth defects of all sorts, Tay-Sach's, and scores of other metabolic defects. Faulty genes also most certainly contribute to the more common killers of our day--cancer, diabetes, high blood pressure, and heart disease.

Over the past several years, biomedical research has increasingly looked to the gene to understand the mechanisms of human disease. The tools of recombinant DNA technology, which were developed nearly 20 years ago, have led us to the doorstep of that knowledge. They have given us provocative glimpses of the wonders we might work if we could only cross the technological thresholds that now keep us from understanding the molecular essence of genetic disorders.

We have undertaken the Human Genome Project to provide biomedical researchers with the technologies and information they need to step across that threshold and into new arenas of understanding and progress.


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