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STATEMENT OF DR. DOMINICK P. PURPURA
Mr. Chairman, I am Dominick P. Purpura, M.D., Professor of Neuroscience and Dean of the Albert Einstein College of Medicine, Yeshiva University, New York. I am a Past President of the Society for Neuroscience and a member of the National Academy of Sciences. The Society for Neuroscience's 18,000 members enthusiastically support the professional judgement budgets (PBJ) of the National Institute of Neurological Disorders and Stroke, the National Institute of Mental Health, the National Eye Institute, the National Institute on Aging, the National Institute of Child Health and Human Development, the National Institute on Deafness and Communicative Disorders, the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.
Neuroscientists hold to the fundamental precept that the brain is the Master Organ whose product is Mind. The brain regulates all bodily functions; the rhythmicity of the heart, the rate and depth of respiration, functions of endocrine glands, blood pressure, excretory functions and the immune system. Sex, appetite, pleasure, pain, cognition, learning, memory and those spiritual and moral values that are uniquely human all emanate from the brain. But the brain and spinal cord are vulnerable to disorders which disable, dement and dehumanize. Its most delicate operations can produce a Bach Oratorio or a theory of Cosmogeny. Its disorders yield purposeless movements, paralysis, hallucinations and a host of destructive behaviors. Neuroscience is concerned with the adequate understanding of all these normal and aberrant functions of the human condition. It labors to take advantage of the felicitous impact of remarkable discoveries and technological advances in molecular and cell biology, molecular and population genetics, and new imaging systems that reveal the folding structure of macromolecules and the brain areas involved in thinking. Most importantly it has facilitated the emergence over the past two decades of thousands of superbly trained investigators prepared to answer the most important question of the Cosmos - How does the Brain Work?
The Society for Neuroscience recognizes the central role it must play in carrying out the Proclamation of the Congress of the United States in establishing this, the Deçade of the Brain. The enormity of this challenge has not escaped our attention. The investigative work ahead built upon the accomplishments of the past will require a level of support that no single federal health sciences' institute or agency can provide within the current framework of appropriations. Hence, the policy for the Society for Neuroscience to endorse the professional judgement budgets of the aforementioned NIH and ADAMHA Institutes that have made significant commitments to neuroscience research and research training. The reason for this is that Neuroscientists are as likely to be exploring the mechanisms of vision and hearing or finding genes involved in the sense of smell, Huntington's Disease and Alzheimer's Disease as they are in studying the neurotransmitters and receptors involved in learning and memory, manic-depressive disease, schizophrenia and substance abuse. Others are equally concerned with how nerve cells can be made to survive catastrophic effects of trauma, stroke and toxins.
The broad spectrum of research program opportunities in neuroscience emerges from a conceptual prism impacted by the single most important element of the professional judgement budget, i.e., the support of individual investigator initiated research projects · euphemistically designated "ROI's". The Society for Neuroscience strongly endorses the principle that - Rol's are the centerpiece of the biomedical sciences research enterprise and must continue to be nourished and enhanced in appropriations to all NIH and ADAMHA Institutes. At the same time we are cognizant of the responsibilities individual Institutes have for supporting and stimulating research and research training through program project and center institutional grants that capitalize on emergent property characteristics that meet specific Congressional mandates.
NINDS is the primary federal agency for brain spinal cord peripheral nerve and muscle research. Virtually its entire budget is dedicated to basic and clinical neuroscience. Opportunities for funding new drugs for epilepsy, Parkinsonism, stroke and dementia are at hand as is the potential for enhancing regeneration of damaged brain and spinal cord systems. (PBJ request: $765M.)
NIMH is the lead agency for neuroscience research into the cause and management of schizophrenia, affective disorders and child and adolescent mental health problems. Its attention to basic neurotransmitter-receptor systems analyses and imaging techniques will provide support for intensive neuroscience research in these areas. (PBJ request: $835M.)
NEI is the agency concerned with research on the visual system which occupies more 'neuronal space' in the human brain than any other sensory system. Research into developmental events responsible for neural pathfinding and target seeking will permit neuroscientists to build a cogent picture of how and what the brain sees - and processes the information into motor memory and cognitive systems. (PBJ request: $342M.)
NIA is concerned with the health of the aging brain. Its support of research into the dementias, particularly Alzheimer's Disease, has revealed new findings on amyloid and fibrous proteins involved in neuronal loss. Genetic and drug studies and new molecular biology probes provide new opportunities for detection, early management and amelioration. (PBJ request: $593M.)
NICHD is the primary agency for the health and welfare of the developing brain of the infant and child. It pioneered in stimulating research in developmental neuroscience and basic mechanisms of mental retardation. Its research programs will impact on identification of perturbations that interdict the elaborate sequential programs of brain and behavior development. (PBJ request: $702M.)
NIDCD is the agency concerned with hearing and human communication including special senses of taste and olfaction. Neuroscience research is discovering ways to encourage regeneration of vital auditory and vestibular hair cells as well as olfactory neurons. (PBJ request: $201M.)
NIDA is a major focus of neuroscience research into brain reward systems at the molecular and biochemical level. Neuroscientists utilizing newly discovered peptides, transmitters and receptor systems cloned from gene families will provide an understanding of substance abuse and treatments for cocaine abuse. (PBJ request: $536M.)
NIAAA is the primary agency for neuroscience studies of the brain transmitter systems and mechanisms of vulnerability to alcohol. The problems of alcohol craving, dependence tolerance, reinforcement and relapse are among the most complex of neuroscience issues. They will require sophisticated neuro · and psychobiological approaches to define their ultimate nature and appropriate therapeutic solutions (PBJ request: $268M.)
The Society for Neuroscience acknowledges that the Institutes of current concern allocate variable portions of their budgets to neuroscience programs per se.
With the exception of NINDS (100% allocation), this may range from 15-60% in other Institutes. Nonetheless, we are persuaded that the programs of these Institutes are sufficiently well targeted to ensure considerable ancillary support for neuroscience research, broadly defined, in the totality of their professional budget requests.
At no time in our recent history has the Congress agonized more intently over appeals for limited resources from competing suppliants. Were cost-benefit analysis to prevail, it seems unlikely that space stations, Ž° particles or dark cold matter would serve the American people more than the knowledge gained from an understanding of Brain. With 80 million citizens afflicted with nervous and mental disorders, at a cost in excess of $300 Billion, questions of priority betray moral turpitude.
Senator ADAMS. Thank you very much, Doctor. We have the “Decade of the Brain" as something that this Senator and I know many others support not only for its value and its belief and that it should happen but because it was started by Representative Silvio Conte, who was a dear personal friend of myself and, I know, many others who is no longer with us. We will sort of dedicate this to him. I agree with you completely.
We have been joined this morning by Senator Specter. We would be most pleased to receive an opening statement from Senator Specter and any questions that he might wish to ask of this witness.
STATEMENT OF HON. ARLEN SPECTER
Senator SPECTER. Thank you very much, Mr. Chairman. I thank all the witnesses for coming and offering very important testimony. I wanted especially to acknowledge three distinguished Pennsylvanians who are going to be testifying here this morning: Dr. Arthur Asbury, who is next, vice dean for research from the School of Medicine, University of Pennsylvania. Dr. Asbury will be representing the National Association of State Universities and Land-Grant Colleges.
Later on this morning, Dr. Alan Schreiber is scheduled to testify. Dr. Schreiber is the assistant dean for research and professor of medicine at the University of Pennsylvania and will be representing the American Society of Hematology.
Later this morning scheduled to testify is Ms. Roseanne English, director, Philadelphia Sudden Infant Death Syndrome Center, who will testify on behalf of the Sudden Infant Death Syndrome Alli
I think everyone knows that we have multiple hearings every day. There are four in process right now which I have to attend, and it is customary that these hearings are usually presided over by a single Senator. Staff is present. We do review the testimony, but I thought that word of explanation might be in order for all the witnesses, especially for the Pennsylvanians whom I will not be hearing. I wanted to extend my wishes in that regard.
Thank you, Mr. Chairman. .
Senator ADAMS. Thank you very much, Senator Specter. If you wish to remain, or if you wish a change in order, please let me know. STATEMENT OF DR. ARTHUR K. ASBURY, UNIVERSITY OF PENNSYLVA.
NIA SCHOOL OF MEDICINE, ON BEHALF OF THE NATIONAL ASSO.
CIATION OF STATE UNIVERSITIES AND LAND-GRANT COLLEGES ACCOMPANIED BY JEROLD ROSCHWALB, DIRECTOR, FEDERAL RELA.
TIONS, NATIONAL ASSOCIATION OF STATE UNIVERSITIES AND
LAND-GRANT COLLEGES Senator ADAMS. We will now proceed with Dr. Asbury, vice dean for research, School of Medicine, University of Pennsylvania.
We are very pleased to have you here, and I know that Senator Specter will be most anxious to hear your testimony.
Dr. ASBURY. Thank you, Senator Adams, Senator Specter. I am here to speak on behalf of the Association of American Universities and the National Association of State Universities and Land-Grant Colleges who endorse the ad hoc group for medical research funding recommendations for 1992 of $9.77 billion for NIH, all programs, and $1.25 billion for ADAMHA.
Now why are such amounts recommended? We all understand the constraints under which the committee is operating and the desperate need for funds in many program areas. Let me just try to give you a long view, a historical perspective, if you will.
For the past 40 years, more or less, the Congress has invested very heavily in biomedical research and in the Nation's health through NIH as the major vehicle, and to me that was the hard part. That was the planting and the sowing and the growing, and now we are to point to where the fruits of that work, I think, can be harvested. We have built a biomedical research capacity that is highly developed and have devised sophisticated and powerful molecular tools. This allows direct intervention and prevention of disease through research, sponsored research in ways never before possible.
The rate-limiting factor is funding to do the research. Let me give you an example. I sit on the Council of the Neurological Disease Institute over at NIH, and our current pay line for project grants is the 17th percentile; that is, one out of six project grants are being funded, and these in turn are being slashed by downward negotiation so that many of them are crippled before they get started.
We could fund at least twice as much research through restoration of those downward negotiations and going lower on the pay line without any loss of quality. So the rate-limiting factor is money, not anything else. Such research investments are cost effective. I think several speakers have already made that point in terms of improved lives and human productivity. The opportunity is there for the Congress to seize, and we hope that you will.
[The statement follows:]
STATEMENT OF DR. ARTHUR K. ASBURY
Mr. Chairman and members of the Subcommittee, my name is Arthur Asbury. I am a neurosurgeon at the medical school of the University of Pennsylvania. It is my privilege to represent today the Association of American Universities and the National Association of State Universities and Land-Grant Colleges. The associations' memberships include 150 university campuses on which the preponderance of medical research conducted in the United States takes place, a fact that all of you are familiar from your own state-based experience. It is the subject of medical research that I address today, most particularly the funding levels for NIH and ADAMHA in the FY 1992 appropriations.
Mr. Chairman, we must note at the outset that we are entirely clear about the extraordinary fiscal constraints under which you and your colleagues in the Congress will be forced lo operate this year. However, we do not find it a contradiction to place before you proposals the cost of which may exceed what you reasonably believe can be spared for medical research. As it is your obligation to set priorities among the various claimants lo available funds in your Subcommittee, it is our responsibility to convey to you our strongest beliefs concerning the funding levels that are essential if medical research in this country is to progress in its mission to prevent, ameliorate, and cure the illnesses that attack all humankind and exact intolerable prices not only in human suffering but, indeed, in tax dollars paid by the citizenry.
11 is the dedication and commitment of you and your colleagues and those members of Congress who preceded you who helped create the extraordinary medical research system represented by NIH and ADAMHA that provides the fundamental justification for our request. By now no one can be ignorant of the impact medical research has had on the well-being of our people, but more important is where this research has led. Across so many disciplines medical research has reached a point of strategic opportunity. The lines of basic and applied research are narrowed. New knowledge gained awaits the next stage of research that will lead to new surgical techniques, medications, vaccines, and other medical technologies that could soon make inroads on the penalties of sickness and disease and injury. It will be tragic is the paths taken and supported so well by you and your colleagues encounter barriers at this opportune moment. It would be a tragedy in the sense that the ancients define tragedy as opportunities unfulfilled. It is important to note that the Administration has built in this underfunding in their FY 1992 proposal. Specifically, the proposed budget is $500 million short of meeting the real costs of the grants proposed.
Our two associations are active participants in the Ad Hoc Group for Medical Research Funding. In essence, we endorse the appropriations recommendations of the group. They include the following. For 1991, we propose $9.77 billion for all of NIH programs. This compares with the FY 1991 appropriation of $8.277 billion and the request for FY 1992 from the Administration of $8.775 billion. At the heart of this recommendation is a conviction that investigator-initiated research is the core of NIH supported medical research. Sustainable growth in this quintessential element of the enterprise is an irreducible part of our perception of the future role of NIH.
We believe that to maintain the nation's leadership position in biomedical research there must be adequate appropriations to fund at the very minimum one-third of the proposals recommended by reviewing stuciy sections. Further, they must be supported at the level of runding determined hy experts as required to implement the research plan in the proposal. In recent years. under the pressures of inadequate funds and the demand that reasonable numbers of scientists be supported, NIH has resorted to regrettable mechanisms that appear to create more funds. In fact, so-called "downward negotiations," now referred to as "adjustable worth" or other terminology. vitiate the health of medical research. concur with the recommendation of the Congress in last year's appropriations bill that called for scientific judgment to determine proper funding levels and fully funding awards at those levels.
Research centers often serve as bridges between basic research and their application. They take a variety of forms and structures, often in highly specialized areas of research and they include the General Clinical Research Centers. The recommendation that a limitation be placed on their number could help create an arbitrary barrier 10 research