« PreviousContinue »
"memory centers" to release more neurotransmitter. Studies of single nerve cell activity are feeding into better understanding of brain circuits activated by normal cognitive functions or affected by disease.
Brain imaging technology continues to push back the limits of our
ability to study the living brain. Experiments with positron-emission tomography (PET) have linked discrete areas of the brain to word-processing tasks and have confirmed the unique role PET has for understanding the higher cognitive functions. New PET tracer chemicals are opening the door to view the working circuitry of the brain. MRI has been established as a critical' tool for research on neuro-AIDS and multiple sclerosis (MS); new studies will further elaborate understanding of how MS attacks the nervous system and will be very important in evaluating the effectiveness of treatments. The application of several techniques to the same research problem is proving very fruitful; PET, MRI, and magnetoencephalography (MEG) provide
complementary information necessary to precisely diagnose and localize the epileptic focus--especially critical when considering surgery. Ongoing research seeks to overcome technological barriers to better integrate data from PET and MRI. These exciting opportunities underscore the importance of brain imaging centers in which these technologies could be integrated and applied to brain research.
Exciting work with neural prostheses points the way to restoration of function in the damaged nervous system. A neural prosthesis that will utilize extension movement in the wrist to control opening and closing of the hand is under development. A brain probe containing both electrodes and cultured neurons is being developed to make very specific connections with the central nervous system. Scientists are also studying genes called into action after traumatic injury to the nervous system for their potential to promote nerve cell growth and regeneration.
The declaration of the 1990s as the Decade of the Brain has generated new enthusiasm among neuroscientists, stimulated international collaborative research efforts, and provided a focus for efforts to highlight and maintain the U.S. lead in research, medicine, and biotechnology. The promise of the "Decade" has provided in its first year new treatments benefiting many Americans--treatments which in many cases have the added plus of being
inexpensive or cost-saving. The potential for further progress, as outlined in the "NINDS Implementation Plan for the Decade of the Brain," impacts particularly vulnerable segments of our population--elderly, children, and minorities--and encompasses many of the major health care problems facing the nation today, such as AIDS and drug abuse. Significant progress has been achieved in the neurosciences in just the past few years. We are optimistic that in the year 2000, when we look back to see what has been accomplished in the "Decade of the Brain", we will be pleased with the progress made in understanding the human brain and significantly improving the quality of
Mr. Chairman, the FY 1992 budget request for this Institute is $583,355,000. I am pleased to answer any questions you might have.
BIOGRAPHICAL SKETCH OF DR. MURRAY GOLDSTEIN
October 13, 1925, New York, New York
EDUCATION: B.A., New York University, 1947; D.O., Des Moines Still College of Osteopathic Medicine, 1950; M.P.H., University of California, School of Public Health, 1959; Mayo Clinic (Neurology), 1968.
PROFESSIONAL HISTORY: Director, NINDS, 1982-present; Acting Director,
PROFESSIONAL ORGANIZATIONS: American Academy of Neurology; American
HONORS, AWARDS: Beta Alpha Epsilon, Biology National Honor Society, NYU; Psi Chi, Psychology National Honor Society, NYU; Sigma Alpha, Osteopathic Scholarship National Honor Society, College of Osteopathic Medicine; Delta
Omega, Public Health National Honor Society, University of California; Doctor
ACUTE SPINAL CORD INJURY
Senator HARKIN. Thank you very much, Dr. Goldstein.
I understand there are nerve cells that are damaged by trauma and repair themselves if you get to them with 8 hours, you say. Dr. GOLDSTEIN. Yes, sir; in the spinal cord.
Senator HARKIN. The spinal cord.
What do you do? What kind of a treatment is it? Let's say that someone has broken their neck or broken their back or something like that. And the spinal cord, obviously, has not been severed. It has been bruised.
Dr. GOLDSTEIN. That's right, sir.
Senator HARKIN. What do you do? What is the treatment? What do they do?
Dr. GOLDSTEIN. There is a drug that is commonly available on shelves in emergency rooms. It is not a new drug. It has been there for years. That drug in one large amount, an overwhelming amount—and that was the amazing thing about it-is given to the patient intravenously immediately and then for 24 hours. That drug prevents the damaged nerve cell from dying. It gives it the opportunity to be protected from the deadly process killing it and then begin to repair itself.
The treatment, by the way, costs about $100, and it prevents a lifetime of severe disability, often being confined to a wheelchair. It is as simple as that.
The drug is so innocuous that if the physician think's the patient may have a spinal cord injury and is not sure, it is well worth giving the drug. It costs about $100 and it does not have a deleterious side effect. It can have a tremendous positive effect.
Let me volunteer the next question, and that is will it work in the brain, a head injury. We don't believe it will.
CHRONIC DEGENERATIVE BRAIN DISEASES
Senator HARKIN. How about Parkinson's disease?
Senator HARKIN. I mean early intervention. Not that drug, but could there be early intervention for things like Parkinson's or Alzheimer's, things like this?
Dr. GOLDSTEIN. I think I understand your question
The scientific issue is shared with my colleague in the Aging Institute-and we work closely together on it. The focus of NINDS attention on Alzheimer's disease and Parkinson's diseases and other degenerative diseases of the brain, which we have singled out for priority attention, is not the patient who has advanced Parkinson's
disease, but the patient who is just beginning to show the early symptoms. Can we arrest the development of the disease? Can we stop it before it becomes incapacitating? Again, I remind you, once a brain cell is dead, it is gone forever.
We have evaluated one drug which was released last year called deprenyl which seems to arrest the progress of Parkinson's disease. We are following patients on that drug because the issue is, can we delay the need for use of L Dopa. Patients with advanced Parkinson's disease get the drug L Dopa, but there are side effects to L Dopa. And the thought is can we delay the progression of the disease so that they do not need L Dopa for 2, 3, 4, or 5 years. And the answer is, yes. The drug is now available.
What we are trying to do now is improve on that drug. It does not work on Alzheimer's disease.
ALZHEIMER'S DISEASE COORDINATION
Senator HARKIN. We have two back-to-back votes.
I had one other question, Dr. Goldstein, on Alzheimer's. Your Institute got a $12 million increase for Alzheimer's research in 1991, a total of $34.5 million.
Dr. GOLDSTEIN. Yes, sir.
Senator HARKIN. There were eight other institutes that spend funds on Alzheimer's research as well as the National Institute of Mental Health.
Dr. GOLDSTEIN. Yes, sir.
Senator HARKIN. It has been suggested to this committee that a new office to coordinate Alzheimer's research may be useful. What is your view? Do we need an office to coordinate Alzheimer's research?
Dr. GOLDSTEIN. Sir, in terms of the Federal establishment and particularly the NIH institutes and NIMH, we already have that coordination in operation. In the Office of the Assistant Secretary, a committee is functioning which does coordinate the national Alzheimer's disease effort. My colleague, Dr. Williams, is a key person in the running of that committee. I am not really sure what another layer of bureaucracy would accomplish which that committee isn't already doing very effectively. I already see more of Dr. Williams about Alzheimer's disease than I want to, sir. [Laughter.]
Dr. WILLIAMS. It's a pleasure. [Laughter.]
Senator SPECTER. Mr. Chairman, we have a full Appropriations Committee markup at 2:30, had you heard, on the appropriations bill?
Senator HARKIN. Well, I was told.
Senator SPECTER. I wonder if I might ask Dr. Goldstein just one question. I had written you, Dr. Goldstein, back on February 11, concerning Gaucher's disease type III research.
Dr. GOLDSTEIN. Yes, sir.
Senator SPECTER. Ánd I had requested a response prior to the hearing today. And we did receive a telephone call yesterday about it. But the question I have is was there insufficient time for you to respond in writing in the intervening month?
Dr. GOLDSTEIN. Yes, sir; the problem is that there is a research protocol that has to be developed specifically for type III. It is a somewhat different disease from type I, and we couldn't use the type I research protocol. We have been diligently trying to get the details of that protocol developed and introduce it into the scientific review process. I apologize that we were able to get our act_together only yesterday. But it was too late to write you, and that is why we called.
Senator SPECTER. Well, if you have a problem on getting the information together in the interim, say from the February 11, 1991, letter to the March 14, 1991, hearing date, I would just appreciate it if you would drop us a note and tell us what the progress is.
Dr. GOLDSTEIN. You will absolutely have the information this coming week, sir.
Senator SPECTER. Well, my point is to let us know, if you could, in writing in advance of the hearing date
Dr. GOLDSTEIN. Yes, sir.
Senator SPECTER [continuing]. As a matter of future reference. Senator HARKIN. I do have a problem. I was just informed_not more than 30 minutes ago that we have a full committee markup on the supplemental at 2:30.
Senator SPECTER. Yes, that's what I commented. I regret it myself, but we are at the call of the Chair. And when the Chair calls the full committee, the full committee responds.
Senator HARKIN. I assume that we will get a quorum. I had to cancel next Tuesday, the incoming Secretary of Education, because of the delay and everything, and we are rescheduling him in April sometime. I do have some time on Tuesday morning, Dr. Raub, that we could use to finish.
We have to go vote. We have two back-to-back votes. I will have someone go with me. If I see my way clear to get back here in about 20 minutes, I may ask you to stay. And if it looks like that I have to be there for the opening of the full committee, I will send word back and we will just dismiss you and see if you could come back next Tuesday morning.
Dr. RAUB. Fine. We are here at your pleasure.
Senator HARKIN. So, if you can give us about 20 minutes, I will know in about 20 minutes whether I can come back or not.
Dr. RAUB. OK.
Senator HARKIN. Thank you very much.
[A brief recess was taken.]
Senator HARKIN. The subcommittee will resume its sitting. I appreciate your staying here. We had two votes.
I thank you for the applause, but it really should be for Senator Byrd. I went to him and said we had all of you here and you came all the way down from Bethesda and Rockville and down here from NIH. I said we cannot have them turn around and come back, waste gas and time, all these important scientists. So, he said, OK, we'll bring you up first. So, we got up first and got out of there. So, that is why I am here. The rest of them are stuck over there till about 7 tonight I think. [Laughter.]
Actually, I want to thank you also. I didn't want to sit there till 7 either. [Laughter.]
Dr. GOLDSTEIN. I was about to say you owe us one, Senator.