STATEMENT OF THE CONJOINT COMMITTEE ON
DIAGNOSTIC RADIOLOGY

Mr. Chairman and members of the Subcommittee

My name is William Brody and I am Chairman of the Departmei of Radiology at Johns Hopkins Hospital. I am here today on behalf of the Conjoint Committee on Diagnostic Radiology.

By way of background, the Conjoint Committee is composed of representatives from the American College of Radiology, the Association of University Radiologists, and the Society of Chairmen of Academic Radiology Departments. The idea of drawing these organizations together for a common purpose was conceived in 1978. While our field is noted for the rapid pace of new knowledge and innovations it generates--what some have called medicine's new vision--our common purpose has always held clear and steady: namely, to promote and support the advancement of diagnostic radiology research and education.

Over the past 50 years the advances in medicine have been truly remarkable. These advances came as a result of extensive basic and clinical research and diagnostic radiology played a significant role in these advances at university research centers throughout the country. The field of diagnostic radiology in and of itself experienced more dramatic changes in the past two decades than any other specialty.

Today, medical imaging procedures account for, or directly contribute to, the final patient diagnosis in more than 75 percent of all hospital admissions. Many of these procedures apply as well to the outpatient environment.

But at no time in the past has the field of radiology offered more opportunities for research that could directly enhance our ability to diagnose diseases that continue to plague our society. Such areas as nuclear medicine, computed tomography, ultrasound, nuclear magnetic resonance imaging, and what is being called "filmless" radiology are on the cutting edge of progress in diagnostic medicine.

The promise these and other advancements hold cross the boundaries of practically every scientific and medical discipline--from pediatrics to geriatrics and from family practice to microsurgery. Advances in imaging techniques have enhanced the diagnosis and treatment of virtually every disease, from congenital heart disease in infants to helping unravel the mysteries surrounding Alzheimer's disease in our elderly.

Mr. Chairman, two years ago the Subcommittee recognized that overall progress in the field of diagnostic radiology is seriously hampered by the fact that NIH, arguably the most prestigious research institution in the world, had no single research focus in this area.

No where within the intramural programs at NIH was there a diagnostic radiology component to carry out some of this impor

tant research or to assist the various institutes. For that matter, neither has there ever been a comprehensive effort to build a research agenda that capitalizes on the dynamic changes going on in this field.

As a first step, this Subcommittee directed the NIH to establish an intramural research laboratory on diagnostic radiology. With that you set in motion a series of actions that have helped forge a true spirit of cooperation and collaboration between the NIH leadership and our Conjoint Committee.

First, as an outgrowth of this close working relationship, NIH is currently interviewing several excellent candidates to fill the position of laboratory director. We anticipate the position to be filled within the next few months. Second, the NIH is in the process of establishing a two-year training program for individuals who have recently completed clinical training in radiology. I am pleased to report that over twenty-eight young radiology investigators submitted applications for the five available fellowships, an extraordinary response to this new endeavor. To date, three fellows have been recruited. Lastly, by this fall, NIH will have in place the instrumentation, technical support, and space required to launch the intramural program.

Mr. Chairman, thanks to this Subcommittee, we have made considerable progress. But we still have a way to go.

The nature of diagnostic radiology is such that this field of investigation does easily fit within the existing research institute structure. Recognizing that fact, a number of NIH staff committees have begun to discuss the most appropriate organizational placement of the laboratory as well as the need for developing a dynamic extramural research program.

For its part, the Conjoint Committee in the coming months will develop a comprehensive research agenda that will capitalize on the full potential this field holds for health and medicine.

We will also address the problem of organizational placement in a way that will enable NIH to achieve the goals this Subcommittee set out for diagnostic radiology.

Once again, Mr. Chairman, thank you for your continued leadership and support in this endeavor. I would be happy to answer any questions you have.

0400

STATEMENT OF THE AMERICAN FEDERATION FOR CLINICAL

RESEARCH

The American Federation for Clinical Research (AFCR) is pleased to submit this testimony regarding FY 1992 funding for the National Institutes of Health (NIH).

The American Federation for Clinical Research is the nation's largest organization of medical investigators and is comprised of more than 13,000 physician and nonphysician scientists who are engaged in virtually every area of medical research. Its members include many distinguished medical investigators among them,

winners of the Nobel Prize in Medicine.

The programs of the NIH are of special importance to the AFCR membership. Most of our members are based in universities and receive funding for their research from the NIH extramural program and on their behalf, the AFCR would like to express its appreciation for the Subcommittee's continued leadership in advocating increased federal funding for biomedical research.

Without adequate funding, the NIH simply will not be able to keep up with today's explosive scientific opportunity. Furthermore, it will not be able to keep up with the needs of Americans suffering from cancer, AIDS, cardiovascular disease, Alzheimer's disease, juvenile diabetes and countless other diseases for which treatments are incomplete or nonexistent.

NIH-sponsored research continues to make tremendous contributions both to the alleviation of human suffering and to reducing the cost of health care. For example:

NIH-sponsored research resulted in the vaccine for hepatitis B, which prevents acute, chronic illness and saves between approximately $50 million and $100 million every year.

Recently, scientists discovered that a combination of cancer treatments widely available in community hospitals has been shown to reduce the number of deaths from rectal cancer by one-third and the chance that the disease will return by nearly half.

Researchers have uncovered preventive measures for the
recurrence of kidney stones. The drug, potassium citrate,
was approved by the FDA in 1985 and is now being marketed.
Cost savings are estimated at roughly $300 million to
$600 million every year.

O Nearly 900 newborns can be saved every year from a
lifetime of stunted physical and mental development through
the development of a mass screening device for neonatal
hypothyroidism, with a potential cost savings of $206 million
each year.

a

Research sponsored and conducted by the NIH has made tangible difference in the lives of Americans suffering from these diseases and their families.

Unfortunately, the president's FY 1992 budget request of $8.77 billion, a slim 6 percent increase over this year's funding, will not enhance the NIH's ability to remain at the forefront of the world in biomedical science. While the small, gradual raises the NIH has received over the last several years look good on paper, the number of meritorious grants that receive funding tells a very different story.

The number of NIH-funded competing research grants has fluctuated dramatically in recent years, and the president's request would fund only 5,785 competing grants, which is the same number as this year and well below the 6,450 the NIH supported in

1987.

What does that really mean? It means that only one of every four competing research projects will be funded and that three out of four applicants will not receive support for their proposals to study a host of diseases and disabilities.

For FY 1992, the AFCR supports the Ad Hoc Group for Medical Research Funding in recommending an NIH budget of $9.77 billion. This funding level would enable the NIH to support approximately one-third of competing and total investigator-initiated research project grants; 12,586 research trainees under the National Research Service Award program, as recommended by the National Academy of Sciences; and 250 additional research career development awards, which would bring the total up to nearly 1,850. It would provide modest growth for the intramural program, NIH buildings and facilities and research centers.

Cutting back on funding for many programs is attractive in light of the spending constraints of the budget agreement. The problem with cutting corners in funding the NIH is that not only will we miss opportunities to move toward cures or treatments for human diseases, but "saving" money by underfunding the NIH will not save money at all. In fact, it will cost the entire nation in health care bills that continue to soar because a less expensive treatment or vaccine is not being researched.

are

Allocating a proper level of funding for the NIH is a matter of setting priorities for our nation because although federal dollars are tight, other research and development programs being recommended for sizable, well-above-inflationary raises. The NIH is just not one of them. For example, the president's FY 1992 budget request calls for a 120 percent raise for the Superconducting Super Collider, a 13 percent raise for NASA and a 23 percent increase for housing research.

The NIH has made invaluable contributions to the health and well-being of our nation. However, in order for that to continue, research conducted and supported by the NIH must be adequately funded.

Thank you for reviewing AFCR's position on the need for increased funding for the NIH.

0402

JOINT STATEMENT OF THE ASSOCIATION OF UNIVERSITY PROGRAMS IN OCCUPATIONAL HEALTH AND SAFETY AND THE NATIONAL OCCUPATIONAL SAFETY AND HEALTH EDUCATION ASSOCIATION

Mr. Chairman:

I am Ian Greaves, the President of the Association of University Programs in Occupational Health and Safety (AUPOHS) and I am Arthur Frank, the President of the National Occupational Safety and Health Education Association (NOSHEA).

The purpose of this statement is to urge you and your committee to consider our views concerning the need for additional funding for the National Institute for Occupational Safety & Health (NIOSH). We request that it be made a part of the permanent hearing record of your committee's consideration of the Labor-HHSEducation appropriations bill.

The Association of University Programs in Occupational Health and Safety (AUPOHS) represents the 14 regional universitybased Educational Resource Centers (ERCs) which are multidisciplinary programs that operate under training grants from

NIOSH.

The National Occupational Safety and Health Education Association (NOSHEA) represents some 25 additional regionally based university single-disciplinary training grant programs in occupational safety and health professional development and education, also funded by NIOSH.

Thus, the combined ERC and Training Grant Programs involve 39 university-based programs that account for nearly all of the professional development and education in the field of occupational safety and health. (See the attached listing of all 39 university programs).