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lead to the expansion of studies of the molecular, cellular, or immunologic bases of the communication sciences and disorders, and the availability of other services and resources may encourage expanded, multidisciplinary and/or collaborative studies in the communication sciences and disorders.

We are funding three RTCs in the areas of voice and speech, hearing and balance, and hearing loss in children.

The Request for Applications for the new National Multipurpose Research and Training Centers (RTC) was issued on December 22, 1990. As of February 21, 1991, the Institute has received six applications in response to the RFA. The awards for these new Centers will be made by September 1991. The focus for these Centers will be determined by the applications approved for funding by the National Deafness and Other Communication Disorders Advisory Council. goal is to support one RTC in each major program area of the Institute.



Question. Your intramural research program represents only 4.5 percent of your overall budget, well below the average for NIH as a whole. What plans do you have for your laboratory programs?

Answer. In the past year, we have added additional staff to our Intramural Program. We have ongoing programs in speech, voice, and audiology, as well as basic research in molecular biology. We have selected a permanent Scientific Director, and will bring him on board in FY 1991. Once this has occurred, we anticipate a significant expansion of both our clinical and basic science research activities within the Division of Intramural Research. current plans call for the establishment of four clinical branches and five basic laboratories.

Question. Have you been given adequate space?

Answer. NIH has allocated additional space for the intramural research program. This space will permit the Institute to consolidate its current activities as well as expand its program efforts into other areas of communication sciences and disorders. This additional space should be adequate for our current needs.


Question. What difficulties have you experienced in recruiting scientists for areas of your program that you would like to expand?

Answer. The Institute is experiencing the same problems in recruiting and retaining experienced research scientists as other institutes at NIH. NIH's inability to offer competitive salaries and the limited portability of benefits are the main problems.


Question. What research do you support that may shed light on the best methods of educating hearing-impaired children and teaching them language?

Answer. A number of currently-supported NIDCD research projects are addressing the most efficacious methods of providing

language input to hearing impaired children. Some studies examine
the use of hearing aids vs. cochlear implants vs. tactile devices
and document gains in speech and language skills associated with
each device. Results will assist professionals in determining which
device is most appropriate for hearing impaired children with
particular characteristics (for example, degree of hearing loss, age
at loss of hearing, family characteristics, etc.). Other research
projects examine more advanced language skills and reading and
writing abilities to identify factors associated with successful and
unsuccessful acquisition of those abilities. Such information will
guide educators in assisting deaf students in acquiring higher
levels of literacy than has been characteristic of this population
in the past.

Question. Are any of the long-standing controversies over sign language, cued speech, and oral-only approaches being clarified by new research results?

Answer. Current initiatives are soliciting research studies to examine language acquisition in deaf children of deaf parents learning a signed language, as well as in deaf children of hearing parents learning oral communication. These investigations are expected to speak to and resolve some of the issues associated with the long-standing controversy over the most appropriate means of teaching language to deaf children.



Question. Dr. Snow, I understand the Institute is planning to implement a "mentor" training program. Would you please describe for the Committee the program and its purpose, and is there an adequate pool of trained researchers in the area of deafness and other communication disorders?

Answer. The purpose of the "Mentor" program is to increase the pool of researchers particularly in molecular biology and molecular genetics who are doing research in communication sciences. The "mentor award" would permit research project investigators to apply for a supplement that would enable them to support an individual at the postdoctoral level who is interested in enhancing his or her basic research skills. The support would be for no less than two and no more than three years. We believe that molecular biology and molecular genetics represent the most promising area of biomedical research for emphasis and that by developing more of these investigators in the communication sciences, we will hasten the search for answers in this field.


Question: Dr. Snow, concerns over the lack of attention given to women's health issues at the National Institutes of Health have been raised both in the press and in the Congress. Has your Institute identified any areas for research focus that have particular relevance to women's health?

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Answer: The NIDCD has identified five areas of research for study that are particularly relevant to women's health:

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Meniere's disease is a very difficult disease characterized by periods of dizziness, nausea, vomiting and loss of hearing. Scientists in one NIDCD research program have demonstrated an inner ear response to a particular virus, cytomegalovirus (CMV). CMV is a well-established cause of disorders of the auditory, visual and central nervous systems. Some surveys have established the presence of the virus in 50 percent of upper middle income white females and 83 percent of lower income minority women. "Quiescent" CMV may play a role in the development of Meniere's disease.

• A predominant problem in the elderly is the natural decline in smelling ability that typically occurs after age 60. NIDCD grantees developed a smell identification test that made it possible to test the sense of smell throughout the age span. With this useful clinical tool, when patients complain of a loss of the sense of smell, their sense of smell can be measured and compared to what is normal for their age and gender. Throughout the life span, women have been known to have a more acute sense of smell than men.

Otosclerosis is the most common cause of progressive conductive hearing loss in the adult with a normal eardrum, and it is more common in women than men. An NIDCD-supported physician-scientist has found that a class of drugs, biphosphonates, acts effectively to inhibit bone remodeling. If shown to be effective, these drugs could be used to prevent the onset of otosclerosis in families known to be prone to the disease or to arrest the progression of the disease in persons already affected.

Voice tremor affects women primarily and makes speech difficult to understand. For example, because of the high frequency response of the telephone, voice tremor renders use of the telephone a difficult task. This disorder has a dramatic effect in limiting one's ability to communicate in professional and personal situations. In a definitive study, scientists in the NIDCD's Voice and Speech Section have developed a new treatment, injecting botulinum toxin into throat muscles in patients with this disorder. These injections were very successful in eliminating tremor entirely in some and almost completely in others. Grantees are continuing work on diagnostic methods with voice tremor.

While the ear is the organ of hearing and receives sounds from the environment, the ear also produces sounds itself, called otoacoustic emissions. These sounds emanating from the ear may be useful in identifying the type of hearing loss. They represent one of the specific functions of the sensory cells in the inner ear. In most cases, emissions remain extremely stable over time but females evidence measurable changes with monthly hormonal cycles. These findings are revealing new understanding of the biochemistry of the inner ear and its interactions with noise exposure, aging and drugs such as aspirin.

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Senator HARKIN. Dr. Kirschstein, good afternoon, you're next.

I understand that you have been very busy not only as Director of the National Institute of General Medical Sciences, but also as Acting Director of the Office of Women's Health.

Dr. KIRSCHSTEIN. That's correct, sir.

Senator HARKIN. You are requesting $833 million for fiscal year 1992. This is 9.6 percent more than 1991.

Would you please start off with a brief overview of the programs included in your budget request? Please proceed.

Dr. KIRSCHSTEIN. Thank you, Senator Harkin. I am honored to present the achievements of the National Institute of General Medical Sciences, the Institute that stimulates scientific progress through the support of the most fundamental biomedical research.

I am also pleased to tell you that, as has been the case in almost every year in which I have testified, an NIGMS grantee once again has won the Nobel Prize this year. In 1990, the chemistry prize went to Dr. Elias J. Corey of Harvard University for his contributions to the field of synthetic chemistry. NIGMS has supported Dr. Corey's work for the past 20 years, and he is still at the pinnacle of his career.


But, while NIGMS supports basic research, we also support some research that is targeted toward specific diseases. We have been supporting research using the techniques of structural biology for the design of drugs to combat AIDS. An NIGMS-supported scientist has developed a computer program that uses the three-dimensional shape of the active site of a molecule that is one of the enzymes that is essential to the growth of the AIDS virus. The computer program then found a chemical which will interfere with the growth of the virus by locking onto the enzyme. Now, he has to go further and develop a better molecule; he will then modify the chemical in order to enhance its desirable activity and decrease its toxicity. This ability to plan the structure of a drug based on the complementary structure of a related molecule is a very important phenomenon.

Among the direct beneficiaries of the basic biomedical research that NIGMS supports is the biotechnology industry. Research by NIGMS grantees is yielding techniques that are leading to ways to inactivate viruses to make vaccines, such as Dr. Fauci talked about this morning, to insert modified genes into cells, the gene therapy that you heard about this morning, and to decipher the instructions

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