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of eligible applications. We favor considerably more. We feel this is the most prudent and minimal number that will capture sufficient science to meet the needs of this Nation and have laid out a 5-year plan which has been submitted to this committee.
This plan provides a modest increase only over the congressional stability plan. It calls for in the 1992 year support for 6,143 new and competing grants. By 1996 this would grow modestly based on national growth to 6,502 grants, at that time supporting 25,470 grants in toto for the NIH portfolio. We would recommend a parallel increase for ADAMHA.
Support for the number of postdoctoral and predoctoral fellows should be increased by the recommendations of the National Academy of Sciences. Other elements of the NIH budget should be increased at least by the current biomedical inflation index.
In summary, FASEB plan will restore viability, vitality, and the appropriate opportunity to the NIH program to maintain U.S. leadership in life science research, in its impact which is major in the economic fabric of this Nation through the spawning and growth of the biotechnology industry, in which we are a fragile leader, and, finally, bring the real solutions to the population of this Nation through effective and definitive health care solution which does return, as NIH has provided this year in a handout the cost effectiveness of the return of biomedical research which returns many, many fold annually the investment.
Thank you, Mr. Chairman. [The statement follows:)
STATEMENT OF DR. THOMAS S. EDGINGTON
Mr. Chairman and Members of the subcommittee:
Thank you for this opportunity to speak to the fiscal 1992 funding for the National Institutes of Health and the Alcohol, Drug Abuse and Mental Health Administration. The Federation of American Societies for Experimental Biology (FASEB), which I represent, is submitting testimony on its recently developed five-year plan for restoring necessary viability and effectiveness to the NIH and ADAMHA.
I am Thomas S. Edgington, MD, Professor of Immunology at the Scripps Research Institute, Scripps Institutions for Medicine and Science, La Jolla, Califomia. I am here as President of FASEB, an organization of seven scientific societies representing more than 31,000 working scientists in the field of fundamental and clinical biomedical research.
I wish to compliment this Subconmittee on its long-standing commitment to the national effort in the biomedical sciences and the solutions to disease that can only be realized from such research. The gratitude you receive from the people of this nation and elsewhere is well deserved. You have led the support of these endeavors which have resulted in a revolution of knowledge of human biology, the fundamental causes and mechanisms of disease, and the translation of this knowledge to improved diagnosis, treatment and prevention of disease. This has fostered a level of medical care that not only saves lives and reduces suffering, but in many ways has significantly reduced the nation's staggering health care obligations, now estimated at more than $600 billion annually. Effective "solution" of the diseases through biomedical research is the only rational and effective means of reducing this cost to our people and nation.
NIH has provided updated information in a publication titled, "Cost Savings Resulting from NIH Research support." A continued stream of highly significant advances have resulted from NIH supported applied research and clinical trials which the agency makes clear would not have been possible without NIH-funded basic research. The studies cited in the document, and the research efforts to translate them to clinical benefit, have cost the agency about $800 million at 1989 prices, and are calculated to yield savings that range from a low of $5.2 billion to a high of nearly $6.7 billion annually, an unparalleled return on investment fiscally, and in its human benefit, and in the strengthening of the economic fabric of this nation.
Allow me to cite just a few examples. First, is the development of mass screening technology for neonatal hypothyroidism. This can save close to 900 newborns annually from a lifetime of arrested physical and mental development. NIH estimates that this advance, if implemented, can yield annual savings of more than $206 million with a development cost of about $1.2 million, which is a 170-fold annual return on the investment.
Second, investigators supported by grants from the NIH have developed a laserbased means of reducing the risk of severe visual loss as a result of advanced diabetic retinopathy. The potential savings are estimated at more than $2 billion annually from a research investment of about $48 million, or more than a 40-fold annual return on investment.
These two breakthroughs have their foundation in decades of fundamental, pathbreaking research support from the NIH. This support has permitted biomedical research throughout the nation by experts capable of elucidating the mechanisms of these and other diseases and able to develop enabling technologies that in a long, rational trail of endeavor have led to their culmination in the improved lot of individuals everywhere.
Biomedical research, more than 85% of which is sponsored in the United States by NIH and ADAMHA, has spawned biotechnology. This has resulted in a new industry that is pioneering the application of basic biomedical science for the benefit of mankind through the development for medical use of new recombinant proteins as therapeutics of unparalleled efficacy and new diagnostic methods for health care. Biotechnology also holds the promise of definitively intervening and auring the thousands of genetic diseases that have plagued
mankind for centuries and baffled physicians in their attempts to bring effective care to the public. Biotechnology has proven a vital and productive new industry that, in partnership with basic investigators throughout this nation, has created a new element in the economic fabric of the country, providing jobs that will benefit this nation in many ways. The U.S. is the undisputed world leader in this field, which is still in its infancy. The message is clear. Fundamental life sciences research is one of the most humane, cost-effective and growth oriented programs that is fostered by the Federal government. The support of research annually returns the investment many times over. It will continue to do so if this remarkable machine can be maintained in working order. Failure to maintain this endeavor will result in large and undesirable costs to mankind and to the economic base of this nation.
We are at a critical juncture in the support and conduct of biomedical sciences in the U.S. Comfortable with a history of remarkable success, we may think it is time to tum to other more immediate issues. There are no more immediate issues than the health of the people of this nation. There is now a significant body of problems that require solutions and the research that must be done to put us on the threshold of preventing and effectively intervening therapeutically in additional diseases. These include heart and vascular diseases, diabetes and related metabolic diseases, cystic fibrosis, Alzheimer's disease, cancer and many other killing and crippling afflictions. Because of the remarkable advances in understanding of basic life sciences over the past three decades fostered by the NIH, the opportunities for progress and real solutions to aur health problems are greater today than ever before. We must have a national research program equal to the challenge and opportunity. The need is very great! The benefit is far greater!
In February, the Federation convened a consensus Conference in which highly qualified scientists representing its seven independent constituent Societies and the Biophysical Society met to develop recommendations for NIH for 1992 and beyond, and applicable in kind to ADAM A. Upon review of testimony from the federal agencies, and other constituencies, there developed a firm consensus that the U.S. in minder-investing" in biomedical research at a time of unprecedented opportunity and need. The conferees expressed deep concem about the precipitous decline in NIH support for new and competing grant applications of great importance, and the under-finding of non-competing continuation grants through a cost-reduction process euphemistically referred to as "downward negotiations" as well as other under-funding mechanisms. The Research Project Grant mechanism is the mainstay of the national effort in biomedical research. It has been the major source of original biomedical "discovery science." Without this program the solutions to critically important questions in basic and clinical medical science will not be found.
The FASEB Consensus Conference, the first of its kind forthcoming from FASEB and its constituent working scientists, pointed out that in fiscal 1990 NIH funded only about 25 percent of approved applications for new and competing grants, an historic low. Only a small percent of the most excellent applications were funded, leaving unmet needs for the solution of disease. Congress also has been concerned about the decline in funded new and competing grants. It has attempted to remedy the situation by pressing NIH to fund 6,000 such grants each year through 1994, to reach the goal of a stable pool of 24,000 awards. However, the agency presently is not on track to achieve this goal.
The FASEB Consensus Conference, Biomedical Research Funding: Fiscal 1992 and Beyond, concluded that the following actions should be taken with respect to NIH funding; and comparable actions should be applied to ADAMHA.
NIH should increase its priority in, and expand its support for, investigator-initiated research project grants. There should be funding of 30 percent of eligible applications each year for the next five years: fiscal years 1992 through 1996. For fiscal 1992, we recommend support of 6,143 new and competing awards with growth to 6,502 by 1996. This would result in a total portfolio of 25,470 new and non-competing grants by the end of the 1996 fiscal year. Although the FASEB analysis calls for slightly more growth than envisioned by the congressional stability plan for NIH, we consider it as
consistent with congressional intent and justified by the research opportunities now available to benefit our society and help solve the fiscal problems of this nation.
NIH and ADAMHA should support the numbers of predoctoral and postdoctoral trainees recommended by the National Academy of Sciences. Trainee stipends should be increased in FY 1992 to reflect levels of experience and be adjusted for inflation thereafter. The Medical Scientist Training Program for combined MD-PhD students should be expanded to meet the needs of this nation; and NIH should create a competitive individual predoctoral training program, comparable to the one supported by the National Science Foundation, to attract more bright graduate students to careers in the life sciences and biomedical research.
Other elements of the NIH budget, containing an agenda of related interests, should be increased at least by the current biomedical inflation factor, or greater depending on specific justifications.
Under the FASEB plan the overall NIH appropriation would increase to $9.7 billion in fiscal 1992. The FASEB request is nearly the same as the request of the Ad Hoc Group for Medical Research Funding. We note the Ad Hoc Group recommendations provide funding for approximately one-third of reviewed research proposals.
It is important to find an effective success rate for investigator-initiated research. The traditional peer review process cannot function constructively at the current rate of federal support. Judgments between first-rate science projects become arbitrary and many excellent proposals from productive investigators doing important work are lost. This causes uncertainty to reverberate through the system, discouraging young scientists from entering the competition, and seasoned scientists to leave.
By funding consistently at least 30 percent of eligible grant applications, NIH can capture the very best biomedical research, the opportunity for truly effective solutions to disease, and restore the vitality of the biomedical enterprise. This suggested level of support is a very conservative one, recognizing the budgetary constraints now facing the nation. But if adopted, it will place the u.s. in a position to capitalize on the major important thrusts in biomedical investigation, leads and results that otherwise will indeed be lost. This minimal level of success of applications will provide the certainty needed to attract the brightest young individuals to research careers, and maintain the fragile U.S. leadership in biotechnology and related areas of endeavor.
NIH training programs are critical to the continued excellence of the nation's biomedical, research and industrial enterprises. Our recommendations are designed to provide for replacing scientists who are retiring by the end of the century, meet increased opportunities in biotechnology and other life science areas, and make careers in the life sciences more attractive to outstanding students, including women and under-represented minorities.
The FASEB plan will restore viability and opportunity to the NIH program and help to maintain U.S. leadership in this writically important area. It proposes a conservative, prudent and stable support base for the most highly meritorious biomedical research and development for the next five years; and it proposes to adjust the rate of growth in trainees to meet generally agreed manpower needs.
Congress has shown vision in regard to the value of biomedical research, and the role which NIH and its sister agency, ADAMA, play in meeting opportunities to benefit the nation. Congress has shown its concer as well, by taking a significant step toward strengthening and stabilizing biomedical research through its support of NIH funding. The consensus plan developed by the constituency of FASEB will help to complete the task and assure continued progress in this vital enterprise. We urge its adoption.
BIOMEDICAL RESEARCH Senator ADAMS. Thank you, Doctor, very much.
I have only one question, and it is really partially a statement and partially a question. I have no question at all about the need for tying together our abilities in biomedical research with an attack on the problems of alcohol and drug abuse. I mean, we simply have to have a better method of treatment than what we are using at the present time.
Your request is $9.7 billion for NIH in 1992. That is the request. That is a 17-percent increase over 1991. If we were to go with what you have proposed, that is a 26-percent increase. You do not have to do it now in oral testimony, but you can do it in written testimony; I just want to have you give me a prioritization of how you think we should go about it if we cannot give you the full amount you want, because I do not know how we can. I state that not because I like it at all but as a necessary tool that this committee will probably need.
Dr. EDGINGTON. I can very simply and very briefly give you a response, if that is acceptable to you, in that the first priority is to capture a sufficient number of grants. It has never in history been below about 33 percent. This year we have fallen to 25 percent. We, therefore, recommend as the first priority funding at least 30 percent, which is about one-half of the most excellent grants to cap ture that science and prevent it from leaving a gap.
The second point which accounts for $500 million of that increase is a result of this 15- to 20-percent across-the-board reduction of all grants below the awarded level. We believe and we propose that as a second priority. I realize the difficulties that certainly exist in the current fiscal year and that perhaps that buyout of this arbitrary across-the-board reduction of everything below minimum levels could be bought out over a series of 2 or 3 years. The first portion, however, if you just capture the necessary science, would bring the budget to approximately $9.2 billion.
Senator ADAMS. I see. The reason I asked that question is that I am continually informed as I visit these clinics, and not just clinics but the treatment centers, the intake centers and so on, that are dealing with the drug crack, for example, that there is really no treatment available as such. In other words, the results of the effect of this drug as opposed to standard cocaine is that it very quickly goes up and down. You release the person, and they revolve back in at a very rapid rate because there are no substitutes or an approach to it.
So I hope you will prioritize by category. I am not suggesting that that is the one you prioritize because I know that alcohol abuse is probably the greatest problem we face in the country, but simply that we might have that from you because I know the committee will need that before we are finished.
Dr. EDGINGTON. Fine.