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Volunteer Program and several other smaller programs which bring foreign scientists into NIH's intramural research program. Specifically, FIC staff analyze visa and immigration requirements, and prepare all documents needed to permit a foreign scientist to come to the United States and to NIH. After arrival, FIC staff handle paperwork necessary to place the foreign scientist into the appropriate intramural research program; provide in-depth orientation to the NIH and the community; arrange for documentation in connection with temporary and permanent departure from the U.S., visa renewal or change of visa status, transfer, and conversion between programs and/or institutes; nonimmigrant tax matters; work authorization for dependents; and a great number of other matters. FIC staff also provide expert advice on the effects of changing immigration policy on scientific exchange.

It should be noted that three non-NIH agencies participate in the NIH intramural research program the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism, both of ADAMHA, and the Center for Biologics Evaluation and Research of FDA. FIC provides the same support services to the foreign scientists invited to work in the intramural research laboratories of these agencies.

Question. How is the responsibility for hosting these scientists shared with the host NIH Institute?

Answer. The host Institute is responsible for supporting the cost of the research and the fellowship stipend or salary, depending on the program, of each foreign scientist. FIC's role is limited to the administrative management of these programs, as described earlier.

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Furthermore, FIC's Volunteer Services Office offers assistance to NIH's foreign scientists in a wide variety of nonresearch related matters, such as orientation to life in the U.S. and the Washington metropolitan area, housing, furniture, child care and schooling, community resources, and cultural events. Although there are no formal rules governing the hosting of foreign scientists, the sponsoring scientist in the host Institute often will provide some assistance on those orientation matters as well.

AFRICAN INITIATIVES

Question. The President sent Secretary Sullivan to Africa in January to determine ways the U.S. could improve the dismal health situation for children on that continent. Does the Fogarty International Center have any plans to help in this situation?

Answer. In response to findings of the Presidential mission to Africa, FIC is developing an African Child Survival Initiative to strengthen health research, training and disease intervention capabilities in Africa. The program will build on our successful experience with regional initiatives in Latin America and the Caribbean, and Central and Eastern Europe, which supplement existing NIH research and training programs relevant to the health problems of these respective regions.

The objectives of the FIC African Child Survival Initiative will be:

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To increase the biomedical research capacity in
Africa by training biomedical scientists and
health professionals in skills necessary to assess
African health and population problems and
cooperate in research studies necessary for their
solution;

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To share and transfer research findings in the
diagnosis, treatment and prevention of childhood
and maternal diseases and disorders;

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To apply the skills of the U.S. biomedical
research community, in cooperation with African
scientists, to develop new and improved
diagnostics, vaccines and other means of
prevention and treatment of disease.

This initiative will offer the dual benefit of increasing biomedical research capacity in Africa and advancing domestic research programs on global determinants of child and maternal health. Expanded cooperation between U.S. and African scientists will enable us to accelerate studies on the transmission of the AIDS virus from mother to child and possibly develop treatment approaches to prevent the onset and progression of the disease. We could advance our understanding of drug and insecticide resistance mechanisms to control the spread of malaria, devise better diagnostic assays and a possible anti-malaria vaccine. We could explore better methods of surveillance for new microbial threats to health, more reliable diagnostic tests and possible new vaccines for pneumococcal infections, pertussis and other respiratory infections of shared public health concern; and we could advance our understanding of viral-induced cancer, a frontier field of oncology with global implications for the prevention of certain cancers. And finally, we could contribute to critical efforts of African nations to devise and implement culturally appropriate and effective family planning and reproductive health programs.

The proposed research program will likely encompass a fivepoint plan consisting of:

1) training grants to U.S. medical institutions to build linkages with African institutions and provide training in laboratory, clinical and epidemiological skills; 2) fellowships for African scientists to undertake training and research activities in U.S. laboratories and for U.S. medical faculty to undertake visiting professorships in Africa; 3) research grant supplements to 'U.S. institutions to develop sister-institute relationships and research partnerships with African institutions; 4) support for the development of five Regional Health Information Centers in Africa to provide research and health care professionals with current biomedical information; and 5) workshops to promote information exchange and research cooperation between U.S. and African health professionals.

This proposed program will be considered for funding in the FY 1993 budget.

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

STATEMENT OF DR. MURRAY GOLDSTEIN, DIRECTOR

BUDGET REQUEST Senator HARKIN. We are now going to shift to our afternoon panel, panel IV, Dr. Murray Goldstein,

Director of the National Institute of Neurological Disorders and Stroke; Dr. Snow, the Director of the National Institute on Deafness and Other Communication Disorders; Dr. Ruth Kirschstein, Director of the National Institute of General Medical Sciences; Dr. Carl Kupfer, the Director of the National Eye Institute; and Dr. Franklin Williams, Director of the National Institute on Aging.

Dr. Goldstein, we have your request for $583.3 million, which is a 7.7-percent increase from 1991. About $30.8 million I notice, or 74 percent of this growth, is for extramural research project grants. The funding for centers, training, and intramural research is held relatively flat. I keep repeating myself with every institute that comes up here. I'm making a point. (Laughter.]

DECADE OF THE BRAIN Again, I have not seen you since the showing of the movie "Awakenings."

Dr. GOLDSTEIN. That's right, sir.

Senator HARKIN. I was very moved by that, and now with Congressman Conte gone, we will all have a little added responsibility to help complete the Decade of the Brain research agenda.

So, Dr. Goldstein, welcome back to the subcommittee and please proceed.

Dr. GOLDSTEIN. Thank you very much, Senator. I have submitted my formal statement for the record and so I will not trouble you by reading it, but rather highlight some more recent developments.

As you know, sir, the Neurological Institute is one of the focal points at NIH for brain research. We have set ourselves two objectives for the Decade of the Brain. The first objective is understanding the human brain. Let me tell you what I mean by that. We really do not know how our brain works. An example. Every dayat least it happens to me-I meet somebody. I recognize him, but I can't remember his name. I do not think the problem is aging or Alzheimer's disease. I just can't remember his name at that moment, but 15 minutes later, I remember it clearly.

Senator HARKIN. I tell you it's the politician's worst fear. [Laughter.)

Dr. GOLDSTEIN. We're working on it. (Laughter.]

Fifteen minutes later, I do remember his name. It wasn't that my memory was impaired, it was that the mechanism for recall wasn't working adequately.

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What is the mechanism for recall? Interesting question. Do we ever forget anything, or is it all stored away and is it our mechanism for recall that isn't working properly? Those are intriguing questions. I am sorry I do not have any answers, but that is what I mean when I say understanding the human brain.

The second issue we address is a more clinical one. Most neurological diseases do not kill, they cripple. They leave the victim with 15 to 20 years of a decrease in quality of his or her life, sometimes a disastrous decrease. In addition, it exsanguinates the emotions and resources of the family who have to provide care for the person whom they love. Our clinical research objective is aimed toward the issue of quality of life, what can we do to make it better for those patients with neurological disease.

Inherent and important in that is once a brain cell is destroyed or gone, it is gone forever. And so, the key to the issue is not treatment. The key to the issue is prevention to make sure we do not lose those brain cells since we are not going to get them back.

Let me give you two examples of things that have happened relatively recently which we consider tremendous success stories.

ACUTE SPINAL CORD INJURY

The first occurred shortly after our last hearings, and that was the treatment of acute spinal cord injury. I think you know about that. For the first time in the history of man we have developed and evaluated a successful treatment for acute spinal injury. It has now become part of the regular practice of medicine in this country and all over the world. If one can treat somebody with a spinal cord injury within 8 hours of that injury, we will absolutely, remarkably diminish the amount of neurological deficit. I have been careful not to say prevent paraplegia because there is a whole spectrum of results depending on the extent of the initial damage. But fundamentally those young men and women and they are generally young men and women-have remarkable improvement, namely, prevention of the fact that they were going to have to spend their lives in a wheelchair.

STROKE

The second important event occurred 2 weeks ago. The fourth leading killer in this country remains stroke. One of the most common causes of stroke is an obstruction in one of the neck arteries to the brain. Surgeons for 20 years have been operating on those vessels in order to take out the obstruction in the neck artery. It is called a carotid, meaning the carotid artery, endarterectomy, meaning they cut out the bad part in the artery and sew the ends together. Carotid endarterectomy has become the third most common surgical procedure in the United States, and until 2 weeks ago, nobody really knew whether it did any good?

We launched a randomized controlled trial 3 years ago in which a group of patients received the best medical treatment available and part of the group of patients also had a carotid endarterectomy. All patients had had the warning symptoms of stroke. The issue was would this surgical procedure be better than medical treatment alone in preventing a stroke.

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