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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 us, not just those who, for the moment, are fortunate to be healthy.

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.



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


the Study of Reproduction.

Our Society is


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

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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

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

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

fur.ded, but also at the time of competing renewal the project will be criticized

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 NICHO 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.

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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 rom 63 in FY 1991 ($42.314 million) to 71 in FY 1992 ($57.5 million). This

unding level for centers would expand the Child Health Research Centers Program

o 15 centers, would allow for the full funding of the recently established five

ew contraceptive development/infertility research centers at the planned level

f $6.0 million in FY 1992, would fund two additional population demographic

enters ($1.0 million), and would support all other currently existing NICHD

esearch centers at maximal performance levels ($8.0 million). The budget which

e support would also increase the number of NICHD trainees from 685 ($17.447

illion) under the President's Budget to 840 ($21.376 million) in FY 1992. Funds

o support bright and enthusiastic young and

ore established scientists are

ssential if the United States is to maintain the position as a world leader in

he field of health care.

n general terms this budget of $702.375 million for the NICHD for FY 1992 would

rovide much needed grant funding for developing newer, more effective, and safer

ontraceptives; for investigating the causes of and developing new treatments for

nfertility; for investigating other disorders of the reproductive system ncluding endometriosis and premenstrual syndrome; for investigating reproductive

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eproductive system including ovarian, uterine and breast cancer in the female,

nd prostatic and testicular cancer in the male; for studying how to prevent

remature labor, low birth weight and infant mortality; for conducting AIDS

esearch; and for investigating basic molecular and genetic mechanisms involved

n the function and regulation of the female and male reproductive systems. The

resident's Budget, if adopted, would seriously impede progress in all of these

ritical areas.

he budget which we are supporting for the NICHD for FY 1992 would assist greatly n alleviating the chronic problem of the underfunding of the NICHD as


nstitute of the NIH. The NICHD has consistently been among the lowest funded of

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