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The NIAMDD Hematology Program activities are complementary to the blood research activities of the NHLBI, and guidelines for the assignment of grant applications are carefully negotiated to avoid duplication of effort. The closest areas of interaction are: first, in research on erythropoietin, where the NIAMDD support studies of erythropoietin in blood cell population and physiological function, while the NHLBI supports efforts to collect, purify, and distribute erythropoietin to investigators; second, in hemoglobin research, where the NIAMDD supports basic studies on the genetics and biosynthesis of a wide variety of hemoglobin types, often as a model protein, while the NHLBI is interested in the hemoglobinopathies such as sickle cell disease and the thalassemias; lastly, the red blood cell is of mutual interest. NIAMDD supports research on the red blood cell as a model for metabolic studies or in anemias of chronic disease, while the NHLBI supports research on red blood cell disorders in certain defined diseases.

The NIAMDD is committed to coordination of research activities in blood, and Institute staff are assigned to the NIH Coordinating Committee for Blood-Related Activities and to the Interagency Technical Committee Working Group on Blood and its Substitutes.

A three-year project is entering its completion which is evaluating the state of the art and research needs in hematology. This should provide NIAMDD, as well as NHLBI, the National Cancer Institute, and other concerned Institutes a better understanding of the current status of research in hematology and the promising directions for future investigations--especially those whose neglect would delay progress in the understanding, diagnosis and treatment of human disease. This is being done through a contract between NIAMDD and the Albert Einstein College of Medicine of Yeshiva University. This major effort involves a central coordinating committee and ten subspecialty working committees of experts in the field of blood diseases and hematology.


Question: During the past decade, several National Commissions were created to study the state-of-the-art on various diseases and to make recommendations for further research. In each case, increased research emphasis has followed. Do you foresee the need for any more National Commissions such as the ones that studied diabetes, arthritis, and digestive diseases? Would kidney diseases be a logical candidate?

Answer: This matter is currently under review by Secretary Schweiker. Once the new Administration's policy has been established, it will be provided to the Subcommittee.

[CLERK'S NOTE.-The following is the administration's response to those questions in the record that were under review by the Secretary at the time the Department submitted earlier responses.]


Question: The Fiscal Year 1982 Budget continues to emphasize the stabilization of new, investigator-initiated research grants at 5,000. How much funding will you need in Fiscal Year 1982 to maintain your share of the NIH goal of 5,000 new and competing research grants?

Answer: The revised budget request proposed by President Reagan provides for the funding of approximately 4,900 new and competing research project grants for $571,621,000. The NIADDK share of that amount is $66,022,000 and 655 grants.

Question: How is inflation impacting

on this goal: What inflator are you using?


or how will it impact


Answer: An inflation factor of 9.5 percent was taken into account in developing the cost of funding the 4,900 new and competing research project grants.

Question: Why is it so important to stabilize new research grants regardless of other budget priorities within NIH?

Answer: The success and effectiveness of biomedical research depends completely on constantly emerging new research advances and findings so that new knowledge is constantly being acquired and, based on it, new methods of diagnosis, treatment, and prevention of diseases can be developed. Without research activities based on the latest new ideas and new findings, there is no progress toward the National priority of more effective treatment, prevention, or recognition of disease. Ordinarily, research grants are awarded by NIH for a period of three to four years. Therefore, each Institute at the NIH carries over from one year to the next an obligation of continued funding of a large number of research projects which must be honored if ongoing research is to continue productively. Thus, about 75 to 80 percent of the budget of a new year is "spoken for"; the remaining percentage of available funds must be secured for meritorious, new research proposals since without them, new progress will cease.

For this reason, it is extremely important to stabilize the number of new research grants and to build a floor below which this number is not permitted to decrease.

Question: What happens if, in a particular year, the quality of new research proposals declines? To what extent would you then want to fund fewer new grants and put greater emphasis on research contracts or intramural research?

Answer: Based on the experience of many previous years, the fluctuation in quality of new research proposals is quite minor. The emergence of new ideas in some fields, or individual facets thereof, tends to counterbalance the occasional loss of momentum which may occur in other facets of related research where unexpected difficulties arrest, temporarily, forward movement. Because of this compensatory action in which progress in different facets of biomedical research tends to undergird other, temporarily

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less active areas, it has usually not been necessary--except for the attainment of specific developmental goals to place greater emphasis on research contracts or to make major changes in the ordinarily very productive intramural research of this Institute.

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Question: To what "payline" will you fund new and competing grants in Fiscal 1981 and if you can estimate it in FY 1982? What percentage of grants will you fund in both years?


Answer: We project a "pay line" of 200 and a funding rate of 39 percent in 1981 and a "pay line" of 180 and a funding rate of 27 percent in 1982.


Question: What are the plans of the Institute to maintain in Fiscal Year 1982 the momentum developed in the past five years for diabetes research?

Answer: The Institute intends to maintain the momentum developed in diabetes research during recent years by funding this effort to the limits of its resources and by capitalizing with new research grants on a vast fund of new knowledge which was developed during the rapid expansion of diabetes research during the past five years.

Question: Would you supply for the record at the appropriate time, material showing spending for diabetes research in FY 1982?

Answer: In 1982 we have allocated $79,475,000 for diabetes, an increase of $3,488,000 over 1981. Diabetes will receive the same proportion of the total funds available to the Institute as it did in 1981.


Question: We have been advised that in recent years the Institute has followed a policy of awarding research grants in certain areas to applicants whose priority scores were higher, and thus represented lower quality than those in other areas of the Institute, particularly by the arthritis "cluster." We now understand that you intend to try to eliminate this inequity by henceforth basing the awarding of research grants solely upon the quality of the application as reflected by the priority score accorded it in the peer review process.

Answer: For a number of years the Institute has developed separate budgets for its ten categorical disease programs. These "program budgets" result in the programs having research grant "paylines" that vary by as much as 50 points. The priorities reflected by these "paylines" have been developed with the advice and recommendations of three national advisory commissions, two national advisory boards, the Institute's national advisory council and most importantly, the reports of the Senate and House appropriations committees. We would anticipate that our program budgets will continue to result in different "paylines".


Question: If faced with a major budget cutback, what are your priorities? Where could cuts be made without impairing essential research?

Answer: In making reductions from the budget submitted to you in January we have attempted to develop a budget which maintains a viable research program for FY 1982 and strikes a balance among research grants, intramural activities and training. While these reductions will not impair essential research, further cuts may alter this balance as well as our research capability.

Question: How much can be saved through more efficient management, less official travel and fewer consultant contracts?

Answer: In 1981 cuts were made in travel, consultant services, procurement contracts and personnel compensation because of the hiring freeze. Further reductions in consultant services were made in 1982. Additional cuts in these areas in FY 1982 could not be absorbed without affecting essential research activities.

Question: Please provide for the record the effects of various levels of funding reduction on your major activities.

Answer: The budget justifications recently submitted to the Congress have attempted to depict the effects of reductions made from the budget proposals submitted in January. These justifications clearly show the levels of funding reductions by budget mechanism and major disease category.


Question: During the past decade, several National Commissions were created to study the state-of-the-art on various diseases and to make recommendations for further research. In each case, increased research emphasis has followed. Do you foresee the need for any more National Commissions such as the ones that studied diabetes, arthritis, and digestive diseases?

Answer: The reports generated by the three national commissions have been of major benefit to the Institute's programs. It is reasonable to expect that commissions studying the state-of-the-art of our other categorical disease areas would be equally beneficial.

Question: Would kidney diseases be a logical candidate?

Answer: Yes. As one of our major programs, kidney disease would be a logical candidate for study by a national commission.


Question: A law passed last year made a number of changes in the Institute, including changes in its name. How will these changes affect your activities?

Answer: The new law will strengthen the Institute organization by formalizing organizational changes which our Institute has

undertaken administratively over the course of recent years in order to be able to carry out its rapidly expanding mission.

Question: To what extent will the Kidney Diseases Program get more emphasis?

Answer: We expect the kidney disease program to maintain its current proportional share of the Institute's budget.

Question: How will you implement the recommendation by the conferees that training of allied health professionals be given special attention in the centers programs?

Answer: The Institute will include the proper wording concerning the availability of stipends for health professionals enrolled in arthritis and diabetes multipurpose center training programs in all future center program announcements and in application directions for renewal of existing centers and for the creation of new ones. It is to be expected that the extent of such training will vary from center to center, depending on the local need and on the resources available to each center. Because of the budgetary constraints already at work, most centers must choose their priorities very carefully and the magnitude of their respective activities reflects this reality.


Question: This committee has for the last several years expressed a specific interest in an expansion of research in the field of arthritis in children. What avenues are being pursued by the Institute in this area?

Answer: The Institute has included arthritis in children in its program announcements to the research community as a special area deserving research emphasis. Meetings have been held with the leaders in pediatric rheumatology research to inform them of our special interest in this field and of the various mechanisms available for support of research training and development. In addition, several interesting projects on arthritis in children are being supported in the Multipurpose Arthritis Centers. These include long-term follow-up studies into adult life, basic immunology research, and the initiation of an epidemiology study.


Question: Would your research proceed faster if you could expand your centers programs?

Answer: The ability to take advantage of the many new and exciting opportunities for sufficient and rapid advancement in diabetes requires the use of all mechanisms of support of research which are available: investigator-initiated research, centers programs, training and research contracts. Centers provide a unique opportunity to bring together in a concentrated environment scientists and physicians from multiple and diverse scientific disciplines to conduct multifaceted and integrated research which bears upon diabetes mellitus. The centers environment also provides the unique opportunity to integrate multidisciplinary research with training,

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