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Additionally, the open heart surgery, needed in many cases, costs thousands of dollars. All too often these families are refused medical insurance and become financially as well as emotionally devastated.

Although we have been making progress and both Congress and NIH have made increased efforts on our behalf over the last several years, there is still so much that needs to be done for the 500,000 Americans with connective disorders and the 20 million citizens who are affected by one of the 5,000 known rare, "orphan" diseases.

I urge you and your colleagues to:

(1) Encourage greater medical education about heritable disorders of the connective tissue such as the Marfan syndrome.

(2) Provide adequate funding for the National Institutes of Health so that they can provide both intra and extra mural clinical and basic research on heritable disorders of connective tissue and other rare disorders.

(3) Establish clinical research centers throughout the country for the diagnosis, treatment and research on heritable disorders of the connective tissue.

There are many demands on our government for funding of various programs. However, none can be as important as the health of citizens today and our future generations. With an adequate budget for NIH programs in general and NIAMS in particular, research could be initiated which would eventually save lives and suffering for many thousands of families. An investment into research will eventually give this country healthier and more productive citizens. There are many capable and hard working people among our constituents who could look forward to each new day if they knew that our government was willing to make an investment in their lives and in the long term good health of our nation. Research will lead to treatments and preventions that will permit our affected citizens and their children to live to their fullest potential. The American dream applies a for all of not just those who, for the moment, are fortunate to be healthy.

us,

As the spokesperson for people with Marfan syndrome and other heritable disorders of connective tissue, I urge this committee to adopt the funding for the National Institutes of Health and the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) as supported by the Coalition for Health Funding. The proposed level of funding, if adopted by the Congress, will enable NIAMS to further its efforts in the area of basic and clinical research and will also enable the Institute to promote its vitally needed training grant program to ensure that research can remain a career choice for bright and promising researchers.

STATEMENT OF THE SOCIETY FOR THE STUDY
OF REPRODUCTION

My name is Dr. James P. Preslock. I am a biomedical research scientist and an Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences of the University of Texas Medical School and Health Science Center at Houston. I serve as the Chairman of the Public Affairs Committee of the Society for the Study of Reproduction. Our Society is an international biomedical research society with a specific interest in basic and clinical research in the reproductive sciences. Our members are the holders of M.D. or Ph.D. degrees, and we serve on the faculties of major medical schools, research institutions, and undergraduate colleges and universities primarily within the United States, but also throughout many countries worldwide.

Our Society continues to be deeply concerned by the continuing crisis in the funding of basic and applied research in the reproductive sciences as appropriated through the National Institute of Child Health and Human Development (NICHD). We are also deeply concerned by the continuing crisis which exists for the funding of new and competing renewal research grants by the overall National Institutes of Health (NIH).

The NIH including the NICHD is continuing to fund competing research grants at perilously low levels. Although the funding of competing grants from FY 1990 to FY 1991 has improved in terms of the number of grants funded, the percentage of grants funded has remained virtually unchanged, and the budgets of funded grants continue to be reduced far below the levels which would permit optimal performance. Unfortunately, the President's Budget for FY 1992 provides no relief from this low level of funding.

The President's Budget would increase the funding for the overall NIH from $8.276 billion during FY 1991 to $8.774 billion during FY 1992. This represents an increase of only 6.0% above current funding levels. For the NICHD the funding would increase from $478.9 million in FY 1991 to $520.5 million in FY 1992, which is an increase of 8.7% above current funding levels.

In terms of the number of competing grants funded, the NIH will fund 5,785 new and competing renewal grants during FY 1991, which is an improvement over the 4,620 competing grants which the NIH funded during FY 1990. The NICHD will fund 372 new and competing renewal grants during FY 1991, which is an increase above the 310 competing grants funded by the NICHD during FY 1990. However, the President's Budget for FY 1992 does not increase the number of competing grants which will be funded by the NIH, which will remain at 5,785, while the number of competing grants which will be funded by the NICHD will improve from 372 during FY 1991 to 409 during FY 1992.

Our Society is appreciative of Congressional adjustments to the President's Budget which have resulted in an overall improvement in the number of new and competing renewal grants funded by the NIH including the NICHD above the record low numbers funded in FY 1990. However, our Society feels that we must continue to work together to further improve the funding of competing research grants by the NIH/NICHD. The success rate for the funding of competing grants remains virtually unchanged from FY 1991 to FY 1992 under the President's Budget. In fact, for the overall NIH the success rate will decrease slightly from a projected success rate of 27.4% in FY 1991 to 26.4% in FY 1992. For the NICHD the success rate will increase only slightly from 22.1% during FY 1991 to 23.9% during FY 1992.

Although there has been an improvement in the number of competing grants funded by the NIH/NICHD since FY 1989, and although there has been an improvement in the percentage of grants funded, these improvements have been achieved through the continued practice of funding competing and non-competing grants at levels far below those recommended by study sections and approved by councils. Although the term "negotiated reductions" seem to have become an expression of the past, the fact remains that the NIH including the NICHD is funding new and competing renewal grants at levels below the amounts approved by review panels. In real terms this translates into an investigator not receiving sufficient funds to accomplish the goals and objectives of his or her research projects. Therefore, not only is the investigator unable to accomplish what has been proposed and funded, but also at the time of competing renewal the project will be criticized

by reviewers as not having accomplished the objectives which were set forth in the research plan.

As recently as FY 1987, both the NIH and the NICHD were enjoying banner years. During that fiscal year the NIH funded 6,447 competing grants at a funding rate of 38.3%. During that same year the NICHD funded 545 competing grants at a funding rate of 35.6%.

The tight funding of research in the reproductive sciences through the NICHD is having a direct impact upon the women and men of this nation. A report released last year by the National Academy of Sciences very dramatically demonstrated the relative dearth of contraceptive choices available to American women compared to their European counterparts. Few new contraceptives have been introduced into the American marketplace since the oral contraceptive pill was introduced nearly 30

years ago.

Infertility remains a serious problem. Approximately one in six American couples are unable to attain pregnancy. Often modern technologies such as in vitro fertilization are pursued in an effort to overcome infertility. However, these techniques are very lengthy, very expensive, and the success rate is very low. The two new centers in infertility research and the three new centers in contraceptive development funded by the NICHD in FY 1991 will begin to resolve these critical problems. However, these new centers are currently funded below maximal performance levels, and the President's Budget does not resolve these critical shortfalls.

In light of the fiscal considerations discussed above, the Society for the Study of Reproduction is opposed to the President's Budget of $520.5 million for the NICHD for FY 1992. We instead recommend a budget of $702.375 million for the NICHD for FY 1992. This budget will permit the maximal performance funding of 684 competing grants ($154.298 million) at a success rate of 40.0%, and would provide for the maximal performance of 1,047 noncompeting research grants ($240.190 million). This budget would also increase the number of NICHD centers

from 63 in FY 1991 ($42.314 million) to 71 in FY 1992 ($57.5 million). This funding level for centers would expand the Child Health Research Centers Program to 15 centers, would allow for the full funding of the recently established five new contraceptive development/infertility research centers at the planned level of $6.0 million in FY 1992, would fund two additional population demographic centers ($1.0 million), and would support all other currently existing NICHD research centers at maximal performance levels ($8.0 million). The budget which we support would also increase the number of NICHD trainees from 685 ($17.447 million) under the President's Budget to 840 ($21.376 million) in FY 1992. Funds to support bright and enthusiastic young and more established scientists are essential if the United States is to maintain the position as a world leader in the field of health care.

In general terms this budget of $702.375 million for the NICHD for FY 1992 would provide much needed grant funding for developing newer, more effective, and safer contraceptives; for investigating the causes of and developing new treatments for infertility; for investigating other disorders of the reproductive system including endometriosis and premenstrual syndrome; for investigating reproductive mechanisms inherent in menopause and its associated problems including osteoporosis; for investigating the mechanism involved in cancers of the reproductive system including ovarian, uterine and breast cancer in the female, and prostatic and testicular cancer in the male; for studying how to prevent premature labor, low birth weight and infant mortality; for conducting AIDS research; and for investigating basic molecular and genetic mechanisms involved in the function and regulation of the female and male reproductive systems. The President's Budget, if adopted, would seriously impede progress in all of these critical areas.

The budget which we are supporting for the NICHD for FY 1992 would assist greatly in alleviating the chronic problem of the underfunding of the NICHD as an Institute of the NIH. The NICHD has consistently been among the lowest funded of

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