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the significant need to rebuild the infrastructure of the CDC. In addition, we strongly urge increased numbers of positions in the Senior Biomedical Research Service, and reserving of sufficient numbers of positions for the CDC, to allow for better retention and recruitment of senior public health physicians and scientists within the agency.

Mr. Chairman, the core programs of the CDC badly need this Committee's appreciation and increased support. Current programs must be stabilized; existing laboratories must be replaced; senior scientific staff must be retained and recruited. The ability to control and eradicate infectious diseases across the country depends on a solid core of scientific capacity to respond to state and local needs. Without this core capacity, other efforts will diminish.


The Infectious Diseases Society of America believes that only through an increase in appropriations above the President's request can the NIAID meet its stated goals for advances in research and training for infectious diseases. Particularly deserving of this Committee's attention is the need for greater and more complete funding of grant awards, adequate increases in trainees and research centers, and attention to targeted research programs. The Congress must take positive actions to insure that the overall scientific fission of the MAID can be accomplished, and that the National Institutes of Health remains a desirable environment in which to study and is worthy of the goals of our nation's best and brightest scientific minds.

We also request that you closely examine the ability of the Centers for Disease Control-through its core programs to respond to local public health needs, with an eye toward restoring and enhancing needed programs.

The infectious diseases community appreciates the consideration of the Senate Appropriations Subcommittee on Labor-HHS-Education for its recommendations and past support for NIH and CDC activities.


Senator BURDICK. The next witness is Dr. Robert Scanlon, Joint Council of Allergy and Immunology.

Dr. SCANLON. Good morning, Senator. Thank you for allowing me to testify today. I am Dr. Robert Scanlon, clinical professor of pediatrics and codirector of the allergy training program in immunology at Georgetown University Medical Center.

I am here to represent the Joint Council on Allergy and Immunology, which consists of 3,500 allergists and immunologists throughout the country. We in turn represent the 35 million Americans who suffer from asthma allergic diseases, infectious disease, immunological diseases.

My intention, first of all, is to thank this committee and past committees for their interest in previous research which has allowed for an explosion in scientific knowledge, including in my field. Unfortunately or fortunately, old solutions have led to new problems, and it is necessary that we continue on with the research. So the joint council wishes to support or speak on behalf of the National Institutes of Health for increased funding of the research, particularly for research training, research grants, research centers, and patient education.

Now, the joint council, because of the diseases, are particularly interested in the National Institutes of Allergy and Infectious Disease, the NIAID, and the National Heart, Lung and Blood Institute. As you know, the National Institute of Allergy and Infectious Disease is concerned with research across the board for asthma and allergy, et cetera. We are interested in basic research, the study of immune cells, their biology-chemistry function inter

actions. And it is important to bring basic labs out into the public, and so the NIAID is also interested in clinical research.

And a new method, thought to bring basic laboratory work and clinical researchers together, has evolved into the cooperative research centers, one in allergy and allergic diseases and the other in immunology. So there are research centers, basic and clinical research.

The National Heart, Lung and Blood Institute is concerned with many diseases, but in our field, with bronchial asthma, No. 1, in research, and No. 2, a program I wish to stress, the national asthma education program, which is essential for dissemination of information not only to the physician's office but to the patients. This is the new trend in medicine, to educate the patient so that they know their disease, they understand the treatment, they know their options, and they can make rational choices.

Now, I had mentioned that there has been an explosion in knowledge, and I would like to use bronchial asthma as an example. Due to the new findings, people are certainly being treated differently with bronchial asthma than they were 20 years ago. There are better results, they have less morbidity, they have less time missed from work, less time missed from school. But I wish to stress that between 1970 and 1987, there was an increased morbidity during this period, but from 1980 to 1987, this was markedly decreased.

What I meant to say was in 1980-87, there was only a 6-percent rise, while in the previous 1970-87, there was a threefold rise. But there is a paradox, Senator, stressing the need for research. The mortality rate has increased, from 2,890 in 1980, to 4,360 in 1987. So we must go on with the research.

Now, because of this, the joint council wishes to support the ad hoc group for medical research, with their budget of $9.77 billion, as opposed to the $8.7 billion in the President's budget. This would allow for a 33-percent approved funding, and would allow for an increase in these grants. We would appreciate full funding and an increase in grants, but if there is a priority, we would recommend full funding.

The increased budget would allow for increased centers, as I said, for the interdigitation of the basic and clinical research, and it would also allow for 12,000 research trainees, which is an investment in our future. And we have to invest in youthful scientists.


I wish to conclude, Senator, by saying that we realize the committee has a lot of budgetary decisions. But in the past, the committee has been excellent in supporting the various aspects, and we wish it to continue with the thought that there is nothing more important in life than good health.

Thank you, Senator.

[The statement follows:]


Thank you Mr. Chairman, my name is Robert Scanlon. I am a Clinical Professor of Pediatrics and the Co-Director of the Allergy Training Program at Georgetown University Medical Center, and a Member of the Board of Governors of the American College of Allergy and Immunology. I am here today testifying on behalf of the

Joint Council on Allergy and Immunology (JCAI) and I would like to request that my written statement be placed in the record.

The JCAI is a professional society which represents the interests of the American Academy of Allergy and Immunology, and the American College of Allergy and Immunology. We represent over 3,200 physicians, both clinicians and researchers in allergy and immunology, working to ameliorate the suffering of the 35 million Americans with allergic or immune disorders.

Before I proceed with my statement, I would like to thank the Chair and the Members of this Committee for the opportunity to testify today. I would also like to express the appreciation of the JCAT for all of this Committee's support of medical research programs in the past. Had it not been for the support of the Congress over the past decade, we would have considerably less progress in medical research to report to you today.

In fact, I would like to stay on the subject of medical research and introduce the three important aspects I will discuss today: increased funding for research grants, support for research centers, and research training. In the view of the Joint Council, these are the most critical needs for research in allergy and immunology, as well as in biomedical research more broadly.


At NIH, two institutes are most involved in research related to allergy and immunology. The National Institutes of Allergy and Infectious Diseases (NIAID) supports basic research in immunology to study the biological and chemical properties, functions, and interactions of the cells of the immune systems. This research is critical in understanding the diseases associated with the immune system, including asthma, allergies, and organ transplantation rejection. NIAID also supports clinical research, as well as efforts to bridge the gap between basic and clinical research. For instance, the Asthma and Allergic Disease Cooperative Research Centers and the Cooperative Research Centers for Immunologic Diseases are two of the NIAID Research Centers which were instituted to promote close coordination between clinical investigators and basic researchers. In addition, the National Heart, Lung and Blood Institute (NHLBI) supports a broad spectrum of research on asthma that encompasses basic, clinical, and educational studies.

And, while funding of these research programs is yielding incremental scientific advances, it is important to remember that allergies, asthma, and other immune disorders continue to cause tremendous suffering and cost millions of dollars in health care costs. One particularly troubling finding came from several recent studies, released in October 1990, that documented increasing mortality rates from asthma beginning in 1978, reversing the trend of the previous ten years when death rates were declining. These new studies have shown increasing death rates from asthma in both young adults and children, among both whites and non-whites. However, the death rates were much higher among non-whites and residents of certain inner cities. These findings only serve to heighten our interest in continuing research on asthma, and on the underlying biomedical bases for this disease and other immunological diseases.

Fortunately, all is not gloom and doom. Due to the investment made in medical research over recent years, exciting new opportunities in the field of allergy and immunology have opened up with the new research technologies associated with modern molecular biology. If the resources exist, there are many scientific opportunities in the field of allergy and immunology that are ripe for investigation.

For instance, with additional funding, NIAID could expand its research on immunodeficiency states and the possibility of using gene therapy to treat them. It could expand its structural biology activities to study problems of the immune system like allergic disorders in greater detail; for instance, we are very interested in understanding the precise role of cytokines in allergic inflammation. A high priority project would be expansion of studies on fatal asthma and efforts to prevent asthmarelated morbidity and mortality, particularly in the inner city.

Due to the increased prevalence, severity, and mortality from asthma over the past decade, particularly among low-income black children, NHLBI should also expand its research efforts in asthma. Specifically, opportunities exist in several areas: mechanisms need to be established to conduct research, direct patient care, disseminate innovative treatment methods, and educate practitioners on optimal care for asthma patients. In addition, NHLBI could initiate studies of the genetics of asthma, expand its studies of the causes and triggers of asthma and of management strategies, and expand the activities of the National Asthma Education Program.

To accomplish these objectives, NIH needs additional resources. Specifically, the Joint Council supports the recommendation of The Ad Hoc Group for Medical Re

search which calls for NIH funding of $ 9.77 billion. We believe that this proposal addresses the funding shortfalls in the Budget Request.

This level of funding would provide for the following:

-Funding for 33 percent of the approved research project grants at study section recommended levels of funding to provide for sustainable growth. JCAI supports both fully-funding grants and increasing the number of grants, with full funding the highest priority. In addition, the substitution of "administrative adjustments" for last year's "downward negotiations" is not a real solution to the problem of insufficient funds for research grants.

—Funding of additional research centers. JCAI believes that the collaboration in centers is critical to bringing advances from the laboratory to the Patient, thus we believe that an arbitrary cap on the number of centers is scientifically unwise.

-Funds to support 12,586 research trainees as recommended by the National Academy of Sciences. JCAI would like to direct your attention to the need for research training, specially at the institutional level. We urge this subcommittee to continue its previous support for research training and suggest that you direct your future efforts to institutional training.

This amount would permit the National Institute of Allergy and Infectious Disease (NIAID) to pursue important current scientific opportunities, some of which I've already mentioned. Now, I'll mention just two that are of particular interest to me-asthma and rhinitis. NIAID could expand its research efforts into the causes and pathophysiology of asthma, including new treatment for bronchial asthma. It would permit NIAID to better investigate the pathophysiology of and to develop therapies for rhinitis.

Funding for NIH at the level recommended by the Ad Hoc Group would also permit the National Heart, Lung, and Blood Institute (NHLBI) to expand its research efforts on women and asthma, and to boost its unique and critically important National Asthma Education Program.

This concludes my formal statement. I would be pleased to answer any question that the Subcommittee may have.

Senator BURDICK. Thank you. Could you describe some of the latest research being done in the area of asthma therapy?

Dr. SCANLON. Well, there is much research, basically, Senator, in finding the cells and how they interact with each other. For example, in asthma, which allergy is a part, there are antibodies produced, and there are cells that stimulate certain cells to produce antibodies and other cells that suppress them. There is much research going on in that area. There are a lot of substances secreted by immune cells called cytokines that stimulate the cells, suppress them, have them increase, have them decrease, et cetera. There is much research being done there, and I should say there is a lot of clinical research being done from a pharmacological point of view, and this allows for extension of basic research to the patient. And so we have made great strides, but we have greater strides to make.

Senator BURDICK. Thank you very much.

Dr. SCANLON. Thank you.



Senator BURDICK. Dr. Carlo Mainardi.

Dr. MAINARDI. Thank you, Senator. I am Dr. Carlo Mainardi, professor of medicine at the University of Tennessee. I represent the American College of Rheumatology, which is the largest professional organization of care providers in the field of arthritis. With me is Mrs. Mary Martin from Des Moines, IA.

Ms. MARTIN. I have been physically challenged with arthritis for 28 years. People are living longer now than in past years. I expect to live a long life, but having suffered from arthritis, I would gladly trade quantity for quality. Arthritis has greatly altered my life and my continued hope is a cure for this disease.

While arthritis is generally nonfatal, it cheats some 37 million Americans from an active and productive life. It is the day-to-day fluctuations and the dramatic swings from feeling energetic to extreme fatigue that is difficult.

Coping with the pain, necessary physical activity, limited physical activity, constant regimen of drugs, laboratory tests, visits to my doctors, and many major surgeries to date for damaged joints, has taken its toll on me, and has contributed an economic burden as well. I am unable to work in my chosen profession as a nurse. And the future concerning my care is uncertain.

I want to express my gratitude for your generous support for funding for NIAMS in fiscal year 1991. I hope you will continue to support arthritis research funding this year. This means a lot to me, and I am certain that I speak for millions of others who have arthritis. Without research there can be no progress, and without money there can be no research.

Dr. MAINARDI. Although a cure for arthritis is the ultimate goal, the quality of life has improved for people with arthritis, due largely the research advances. Exciting discoveries have been made in the past year and are described in detail in our written testimony.


Arthritis research is cost effective. Because we are dealing with chronic, disabling conditions, dollars spent in research often lead to a greater saving in health care costs. Last year, the Members of Congress acted favorably toward the arthritis community by partially correcting a situation caused by an underfunded National Institute of Arthritis and Musculoskeletal, and Skin Diseases.

We are grateful for this and urge you to continue this support, lest arthritis research lose the momentum we have recently gained. Thank you.

Senator BURDICK. Thank you both for making the trip from Iowa, and we will give your request serious consideration. [The statement follows:]


The American College of Rheumatology (ACR) is the world's largest organization of rheumatologists, both physicians and scientists, dedicated to the prevention, treatment and eventual cure of the more than 100 types of rheumatic diseases. We would like to take this opportunity to express our appreciation to the Committee for its support of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). We recognize that in light of the spending "caps" included in the budget enforcement act. discretionary programs will be subjected to tight restrictions this year. We will make two separate points in our testimony, however, which will document the need for increased federal funding for the NIAMS.

1. Funding for the NIAMS deserves special consideration, because an increased federal investment in arthritis research is consistent with achieving long-term health care cost savings.

2. The momentum created by the increase Congress afforded the NIAMS in fiscal year 1991 must be continued, so that the "critical level" of knowledge we have

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