SUMMARY OF CHANGES 1967 enacted appropriation... Unobligated balance reserve.. Comparative transfers within NIH. Transfer to "Operating expenses, Public Buildings Service," General Services Administration_ Total estimated obligations, 1967. 1968 estimated obligations... Total change............. $135,687,000 -1,724,000 -980,000 -12,000 132, 971,000 143,954,000 +10,983, 000 Research grants-The program increase of $5,675,000 will provide $1,556,000 for general research support grants and $4,119,000 for an estimated additional 46 research projects and general increased average costs. Fellowships-The increase of $462,000 will provide for an estimated additional 24 fellowships in 1968. Training grants-The increase of $849,000 will provide for an estimated additional 8 new training centers and for increased average costs in the existing centers. Laboratory and clinical research—The increase of 10 positions and $597,000 will provide for strengthening of clinical investigations, chemical biology and physics, and scientific reporting; for the purchase of additional electronic computing services; and for renovation and equipping of additional space to be provided by relocation of the NIH library. Collaborative research and development-The increase of one position and $2,604,000 will provide for continued development of the Artificial KidneyChronic Uremia Program, and modest strengthening of the scientific communications program. Biometry, epidemiology and field studies-The increase of 2 positions and $9,000 will provide required assistance for present and planned epidemiological and clinical field studies in the Southwestern United States. Review and approval of grants-The increase of 2 positions and $52,000 will provide for strengthening of grants management and analysis activities, and for required electronic data processing costs. Program direction-The increase of 3 positions and $28,000 will provide a modest strengthening of Institute management staff and for required program analysis assistance with reference to Institute programming and budgeting systems. AUTHORIZING LEGISLATION The legislative authority in Section 301 of the Public Health Service Act which provides for the award of grants for research, research training, and fellowships is included in the section of the justifications under the tab, "Preamble Paragraph" in Volume V. The Public Health Service Act, Title IV, National Research Institutes, Part D, National Institute on Arthritis, Rheumatism, and Metabolic Diseases, National Institute on Neurological Diseases and Blindness, and other Institutes"Sec. 431 (a) The Surgeon General shall establish in the Public Health Service an institute for research on arthritis, rheumatism, and metabolic disease. . . .” "Sec. 433 (a) Where an institute has been established under this part, the Surgeon General shall carry out the purposes of section 301 with respect to the conduct and support of research relating to the disease or diseases to which the activities of the institute are directed, through such institute and in cooperation with the national advisory council established or expanded by reason of the establishment of such institute. In addition, the Surgeon General is authorized to provide training and instruction and establish and maintain traineeships and fellowships, in such institute and elsewhere, in matters relating to the diagnosis, prevention, and treatment of such disease or diseases with such stipends and allowances (including travel and subsistence expenses) for trainees and fellows as he may deem necessary, and, in addition, provide for such training, instruction, and traineeships and for such fellowships through grants to public and other nonprofit institutions." Since its establishment in 1950 as an Institute, the National Institute of Arthritis and Metabolic Diseases role in the Federally-supported campaign against disease has been one of growing responsibility. Originally charged with the conduct and support of research into the causation, diagnosis, and treatment of the various arthritides, the rheumatic and collagen diseases, and metabolic disorders, such as diabetes, this initial responsibility has been broadened to encompass many other disease categories. Among them are endocrine disorders, diseases of the gastrointestinal tract, including diseases of the liver and gallbladder, diseases of the blood and bone, urological disorders and diseases of the kidney, numerous other metabolic disorders, both acquired and inherited, such as cystic fibrosis, and the fields of nutrition, orthopedic surgery and dermatology. In pursuit of these goals, relevant fundamental research encompasses the disciplines of biochemistry, chemistry, biology, molecular biology, anatomy, physiology, enzymology, pharmacology, pathology, histology, toxicology and genetics, as they relate to life processes in health and to diseases that fall within Institute purview. Emphasis is placed on the conduct and support of research in fundamental sciences which constitute the foundation of knowledge pertinent to these diseases. There is an urgent and continuing need to expand these research activities not only from the point of alleviating the suffering of millions afflicted with disease but also to further the concept of preventive medicine. As more basic knowledge is obtained through research about normal life processes and factors that create disease or disease conditions, more effective medical means can be found to prevent or minimize diseases or their effect on the body. This is the ultimate goal, one which demands a much greater body of knowledge than is presently available. PROGRAM PLANS IN 1967 AND 1968 Arthritis and Rheumatic Diseases Although lacking the dramatic impact of the "killer" diseases, arthritis is by far the Nation's leading crippler. Because arthritis tends to cripple and disable rather than to kill, it ranks high on the list of chronic diseases from the standpoint of social and economic impact. It causes its victims more prolonged mental anguish and physical pain, agony and misery than any other group of diseases. Surgeon General William H. Stewart recently termed arthritis a national medical as well as economic problem. This evaluation is more than borne out by Public Health Service health statistics which estimate that approximately 13 million Americans today are afflicted with some form of arthritis or related disorder. The economic impact of this insidious disease, no less astounding than the number of victims, is now estimated to be approaching an annual cost of almost $4 billion to the Nation, including losses in tax revenue, costs of disability and other payments, costs of hospitalization, physicians' visits, drugs, physical therapy, nursing home care, and other services. Of the estimated 13 million Americans suffering from arthritis, about 700,000 are so incapacitated as to be unable to work, maintain a home, attend school, or or engage in any recreational activities. The remainder suffer from varying degrees of limitations and restrictions. As a cause of restricted activity and bed disability, arthritis is exceeded only by heart disease, as a workloss cause, it is exceeded by heart disease and gastrointestinal ulcers only. Disability from arthritis in the United States causes an estimated 186 million days of restricted activity, including 57 million bed-ridden days and 12 million days lost from work, each year. The primary goal of research in the field of arthritis is to discover the cause or causes of rheumatoid arthritis, osteoarthritis, and related disorders. Equally important goals of this program are to improve existing forms of treatment and management, and to determine means of preventing arthritis. Additional funds provided by the Congress in 1967 for increased efforts in this field are being employed for the establishment of an Arthritis Coordinated Clinical Investigation Program. This will involve a group of clinical investigation centers of excellence working in close coordination in pursuit of possible solutions and improved therapy utilizing most recent findings, techniques, and developments of promise. Particular attention is being devoted to indomethacin and other new therapeutic agents. The main thrust of present and future research will be into an area where promising new etiologic possibilities recently have been uncovered. Two types of microorganisms recently found to be implicated in joint diseases will be studied in relation to rheumatoid arthritis. Intensive investigations are planned on the possible role of mycoplasmas (microorganisms with characteristics of both bacteria and viruses) in causing rheumatoid arthritis, and viruses belonging to the genus Bedsonia. Arthritis has been produced in monkeys by injecting them with Bedsonia organisms isolated from human patients with Reiter's syndrome, a disease closely related to rheumatoid arthritis. Diabetes Of all the inherited metabolic diseases for which research responsibility lies, diabetes mellitus is the more important and widespread. Today, 4 million Americans are known diabetics. An estimated 5 million more are potential victims. Diabetes ranks 7th as a cause of death due to disease, but this is a misleading, low mark since the disorder contributes significantly to cardiac and cerebrovascular deaths through its vascular complications. The most obvious defect in diabetes is the body's inability to metabolize carbohydrates normally. Underlying the disorder is a basic impairment of insulin activity. Although diabetes today can be controlled fairly well with injections of insulin, through the use of oral antidiabetic drugs, and by the use of dietary measures and controls, there remains considerable need for further improvements in the treatment of this disease and for more effective measures to prevent or to ameliorate its serious complications which are responsible for much of the disability and morbidity connected with the disorder. Immediate research activities and objectives of this Institute in diabetes focus on: elucidation of the nature of the interference with normal insulin activity and of substances which destroy or inactivate insulin after its release from the pancreas; possible modification of recently synthesized insulin fractions or of fractions of insulin from other species to provide a therapeutically effective hormone for improved management of diabetes and to serve as a research tool in studying the mechanism of action of insulin; specific studies designed to suppress development of vascular and neurological complications; studies to improve control of "brittle" or juvenile diabetes; and studies to explore possible use of the oral antidiabetic drugs in postponing the onset of overt diabetes in asymptomatic individuals genetically destined to develop this disorder. Other Inherited Diseases of Metabolism While diabetes is the most important and most widespread of the inherited metabolic diseases, other serious hereditary metabolic disorders for which this Institute bears responsibility include: gout, cystic fibrosis, certain blood disorders, phenylketonuria, galactosemia, Wilson's disease, alcaptonuria, histidinemia, homocystinuria, and various glycogen storage diseases, familial Mediterranean fever, congenital non-hemolytic jaundice and many others. Research plans in these areas will focus on the development of new and more reliable patient management by use of specific drugs, such as copper chelating agents in Wilson's disease, or through specialized diets, as in the galactose-free diet in galactosemia. Metabolic and Endocrine Disorders (unrleated to genetics) Studies belonging to this category comprise fundamental research on normal metabolic processes, studies on non-hereditary metabolic disorders, and investigations in the field of endocrinology and of endocrine disorders. All living cells have in common the phenomenon of "metabolism," consisting of an infinite variety of chemical reactions through which the cells derive energy for life processes and produce various chemical substances needed for life, growth and reproduction. Hormones, the specialized chemical messenger substances produced in the endocrine glands of the body are capable in some instances of modifying specific metabolic reactions and in other of modulating an individual's sexual differentiation before birth, his growth, intellectual development, vigor and drive, reproduction, and senescence. Therefore, through their effects on human metabolism, physiology, and morphology, hormones regulate practically all human normal activity and exert profound influence on a wide array of disorders within the Institute's area of responsibility. Current understanding of hyperthyroidism and hypothyroidism and the known effective methods of therapy and long-term management came about through detailed knowledge of thyroid hormones and of the pituitary hormone thyrotropin which affects the endocrine output of thyroid gland. Similarly, corticosteroid therapy, which is invaluable in treating rheumatoid arthritis, Addison's disease, asthma and other serious conditions, is the outgrowth of our basic understanding of the steroid hormones of the adrenal gland. In addition, fundamental research which led to the isolation and purification of the pituitary human growth hormone (HGH) now allows some children afflicted by hypopituitary dwarfism to attain a substantial measure of growth through HGH replacement therapy. Due to the scarcity of HGH (its only sources are pituitary glands obtained at post-mortem examination), its synthesis holds out the greatest hope for therapy on a large scale for dwarfism. Toward this end, Institute-supported investigators are endeavoring to arrive at an effective method of laboratory synthesis of HGH or to derive a human growth stimulating func tion from bovine growth hormone, by modifications of this substance. |