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facilitate the sharing of resources. Another vital program, which has been decreased significantly in recent years, is the Biomedical Research Support Grant (BRSG) program. We ask that you provide ensure the continuation and expansion of the BRSG.

Qur organizations join with the Ad Hoc Group for Medical Research Funding in requesting $2.770 billion for the National Institutes of Health and $1.254 billion for rescarch and research training at the Alcohol. Drug Abuse and Mental Health Administration. We also join with the Friends of NICHD in asking for $720 million for that institute.

HEALTH PROFESSIONS TRAINING

The President's fiscal year 1992 budget docs not allocate funding for many of the existing hcalth professions training programs, choosing, instcad, to focus monies on expanding programs to train minorities. We recognize the dire need for such programs. One program which President Bush seeks to expand is the National Health Service Corps, especially the scholarship and loan repayment program. Our organizations agree this program should be a priority and ask that this subcommitice

provide $101 million for the scholarship and loan repayment program and $65 million for the field placement program.

However, we also ask that this subcommittee continue to support the Title VII Primary Care Training Grants. This program is a small, but crucial, element to pay for the training of general pediatricians. The funding for this program has decreased each year for almcst the entire decade of the 1980s. At a time when there are so many arcas of this country without sufficient physicians to provide appropriate care for our infants, children and adolescents, it is urgent that this subcommittee provide funds for the General Internal Medicine/General Pediatrics program of Title VII. We recommend $22.5 million for the Title YII Primary Care Training Grant General Intemal Medicine / General Pediatrics program.

CENTERS FOR DISEASE CONTROL

The Centers for Disease Control (CDC) is a unique agency within the Public Health Service. The work it supports affects most Americans. It collects and analyzes data on incidences of diseasc; it investigates outbreaks of "mystery" diseases; it responds to emergencies, such as epidemics. It is also an important source of funds for prevention. For infants and children, for example, it supports the Childhood Immunization Program, screening and prevention activities for lead poisoning, and injury control, prevention and rescarch.

To appropriately support the activities and nceds of the CDC. we recommend a funding level of $2 billion for fiscal year

1992.

AGENCY FOR HEALTH CARE POLICY AND RESEARCH

This relatively new arm of the Public Health Service is the federal government's primary agency responsible for medical effectiveness and health services rescarch. It also supports the training of new health service researchers. Included among the projects it funds through its extramural program are those investigating primary care, the health of minorities and low-income populations, and on the delivery of health care.

We urge your support for the ANCPR and recommend funding it at $208.174 million for fiscal year 1992.

SUMMARY

We thank you for the opportunity to appear before you to present the recommendations of our three organizations for all programs involving rescarch and research training and the financing of graduate medical education.

Senator ADAMS. Thank you, Doctor. I ask you this question because I recently noticed, and we have all been very concerned, about the increase in deaths and the occurrence of measles, a basic disease that is subject to vaccination or immunology. We suggested last year the creation of a so-called cocktail or series or variety of vaccinations combined into one.

Would you answer two questions for me? First, what is the status of that? Second, what do you recommend as to how to reach or get into an intake center these children who are under 2 years of age that are dying at such a rapid rate or getting rubella or measles which are very life-threatening or debilitating in their permanent health?

Dr. DOWNING. First of all, some of the difficulty with the combined vaccine deals with the age at which the vaccine can be given, so that what we have in the case of measles, while the first dose is given at 15 months, as you know, a second dose is now recommended because the first dose has not been holding.

We currently do not have funding for the second dose in the President's budget. That obviously is something which is very important.

At the lower level, as you know, the work on the HIB vaccine has been such that we can now introduce that vaccine with the new one as early as 2 months of

age. So I think that part of the answer to your question is we need to work on another type of vaccine to start measles any earlier, but I think that if we continue with the current one dose supplemented by a second dose, the CDC has suggested that that should be sufficient.

Senator ADAMS. Thank you very much, Doctor. I appreciated your testimony.

Dr. DoWNING. Thank you. STATEMENT OF DR. RUTH E. BILLINGS, UNIVERSITY OF NEVADA

SCHOOL OF MEDICINE, ON BEHALF OF ASSOCIATION OF UNI

VERSITY ENVIRONMENTAL HEALTH SCIENCE CENTERS Senator ADAMS. Next is Dr. Ruth E. Billings, University of Nevada School of Medicine, the Association of University Environmental Health Science Centers.

Dr. BILLINGS. Good morning. I appreciate very much the opportunity to testify before your committee. I am here to testify on the importance of continuing the support that scientists such as myself receive through research and training grants from the National Institute of Environmental Health Sciences, or NIEHS. I would like to summarize the testimony which I have submitted in writing.

Senator ADAMS. Without objection, your formal testimony will appear in the record as though given.

Dr. BILLINGS. I am here because NIEHS has played a critical role in my own career as a research scientist and because I am personally convinced that NIEHS plays a critical role in public health in general and, more specifically, in protecting the public from environmentally related and caused diseases.

I am a toxicologist, and NIEHS has provided funds for my research since 1982. The objective of my research is to understand on a biochemical and molecular level how chemicals in the environment cause disease. Our mechanism or mode of action studies pro

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vide information which will allow predictions about the toxicity of new environmental chemicals and information which is essential to assessment of health risk from environmental chemicals.

Prediction of toxicity based upon basic mechanisms of toxicity such as the research supported by NIEHS in my laboratory and in laboratories throughout the United States is essential to protecting the public from toxic chemicals. The testing, research, and training programs supported by NIEHS, programs distributed across the United States, are of tremendous national importance, and I hope to convince you that the American taxpayer is receiving a very good value for this investment.

Last year's passage of the Clean Air Act and the extension of the Superfund Program are evidence that Congress has recognized the importance of a clean environment and the promotion of public health. NIEHS plays an important role in the understanding of the links between the environment and health, and it has been the only source of uninterrupted, long-term assistance to universitybased scientists studying the effects of environmental agents on human health.

The budget proposed for NIEHS for fiscal year 1992 would support 392 research grants and 17 research centers at a cost of about $97 million. Is this enough? In my opinion, it is clearly not.

I recognize that this committee does not have unlimited resources to expand biomedical research. However, funds appropriated by Congress for NIEHS have been consistently lower than those for other institutes and programs. It is inconsistent with our concern about toxic chemical exposure that excellent research proposals are not being funded and scientists are abandoning research careers in environmental sciences.

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PREPARED STATEMENT How much is enough is a difficult question to answer. However, it is clear that the current project funding rate of about 20 percent, less for very critical investigator-initiated projects, is not providing stability or growth to our biomedical sciences community.

Thank you very much for listening to my testimony. I would be happy to answer any questions.

(The statement follows:]

STATEMENT OF RUTH E. BILLINGS

Good Morning. I am Dr. Ruth Billings. I am a teacher and research scientist at the School of Medicine at the University of Nevada in Reno. I am here to testify on the importance of continuing the support that scientists such as myself receive through research and training grants from the National Institute of Environmental Health Sciences (NIEHS).

I am here because NIEHS has played a critical role in my career as a research scientist and because I am convinced that NIEHS plays a critical role in public health, in general, and more specifically in protecting the public from environmental disease.

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I am a toxicologist and NIEHS has provided funds for my research since 1982. The objective of my research is to understand, on a biochemical and molecular level, how chemicals in the environment cause disease. Our mechanism studies provide information which will allow predictions about the toxicity of environmental chemicals and information which is essential to assessment of health risk from environmental chemicals. It is estimated that complete health hazard assessment is available for less that i per cent of commercial chemicals and toxicity information is totally unavailable for 80 per cent. Even if all the world's scientists directed their attention to toxicity testing by traditional methods, we would be unable to test the chemicals which are covered by existing legislation. Prediction of toxicity, based upon basic research into mechanisms of toxicity, such

the research supported by NIEHS in my laboratory, is essential to protecting the public from toxic chemicals.

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This year, NIEHS provided funds for approximately 400 research programs and centers and 450 training programs. These programs are distributed in institutions across the United States. This work is of tremendous national importance, and I hope to convince you that the American taxpayer is receiving good value for this investment.

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Last year's passage of the Clean Air Act and the extension of the Superfund Program are evidence that Congress has recognized the importance of clean environment in the promotion of public health. NIEHS also plays an important role in the understanding of the links between the environment and health. With NIEHS grant support, scientists in at least 60 universities in 32 states conducting environmental health sciences research directly related to air pollution and/or hazardous wastes. In fact, NIEHS has been the only

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uninterrupted, long term assistance to university based scientists studying the effects of environmental agents on human health.

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The importance of sustaining environmental health sciences research over extended periods cannot be overemphasized. Long-term support to researchers in Boston, Cincinnati and Pittsburgh, was crucial in the discovery of the behavioral and learning disabilities which present in later years from exposure of children to mildly elevated levels of lead. Treatment is now available for children who absorb sufficient lead to cause neurological damage. However, even this is a partial remedy since the medicines now available can cause serious side effects, and in the cases of low level lead poisoning are of limited effectiveness. Researchers supported by NIEHS are working to solve this problem.

The study of lead poisoning is just one area where NIEHS supports university based research. Other areas of activity include radon, agricultural chemicals, electromagnetic fields, dioxin, and other environmental health problems we hear about almost daily. In addition, NIEHS supported researchers are applying new biomedical

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technologies to learn how hazardous substances cause damage inside human organs and cells. This basic approach to the understanding of the cellular and molecular mechanisms of damage may lead to the invention of new diagnostic tools to measure toxic response before irreversible damage is done to major body systems (eg, reproductive,

and immune systems). This basic research will also help predict problems associated with new technologies and environmental alterations and will help make this kind of risk assessment more accurate.

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There are two additional, tangible benefits which derive from the NIEHS grant program to universities. Firstly,

these academic institutions provide the training ground for the needed future scientists, engineers and physicians. The fostering of our academic talent in this area provides the USA with a resource of expertise

needed to evaluate the health impact of specific environmental catastrophes such as are now seeing in Eastern Europe and the Persian Gulf.

However, manpower shortages in nearly* all areas of toxicology are critical. The rapid decline in the availability of federal research funds is having an enormous negative impact on all areas of science, including toxicology. While the actual amount of funds appropriated for the NIH has continually increased, the percentage of approved grants that are funded has rapidly declined. A funding rate of approximately 20% is common among institutes for investigator-initiated individual research grants.

This low rate is very discouraging to senior scientists and is devastating to junior scientists who are trying to

establish a research career. In addition, this atmosphere negatively affects graduate students who are making crucial career choices.

The budget proposed for NIEHS for fiscal year 1992 would support 392 research grants and 17 research centers at a cost of about $97 million. Is this enough? In my opinion it is not. I recognize that this subcommittee does not have unlimited resources to expand biomedical research. I know that funds for environmental health sciences research must compete with compelling pleas from the other national institutes and other national priorities. However, funds appropriated by Congress for NIEHS have consistently been lower that those for other institutes and programs. There are at least two reasons. Firstly, environmental illnesses such

lead poisoning are generally subacute or chronic conditions. Victims are seldom noticed and don't join large vocal advocacy groups. In addition, environmental agents are usually just one factor contributing to conditions such

cancer, reproductive dysfunction, birth defects and kidney, lung neurological disease. Consequently high emphasis is given to major programs to cure disease and too little support is given to the kinds of research supported by NIEHS that contributes to disease preventionA benefit almost impossible to quantify.

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How much would be enough? This is almost impossible for me to answer. However, it is clear that a funding rate of 20% is not providing stability or growth to our biomedical science community. While it is recognized that limited financial resources creates a need for budgetary choices, it is inconsistent with our concern about toxic chemical exposure, that excellent research proposals not being funded and scientists

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research careers.

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I appreciate your willingness to hear my testimony and hope that my comments will be useful in your decisions. I will be happy to answer any questions you may have.

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