This clearly requires more research at the molecular and cellular levels as well as combined and vigorous efforts at the more complex organ, whole body and population levels of study to build on the base of nutritional information.

In

Congressional support has been given for nutritional research funding, but this only amounts to four percent of the NIH budget and more is needed. contrast, food and agriculture contribute more than one-fifth of the U.S. Gross National Product. I again refer to this committee's report to the last Congress that recognized the central role of nutrition in disease prevention and the relative lack of funding for nutritional research. The report stated that "it is notable that so little has been done to build the scientific base of nutritional information that might lead to better methods for complying with recommendations and a better understanding of how to prevent and treat nutritional disorders."

There is difficulty in accurately assessing the size of the research enterprise in nutrition because it is a bridging discipline that cuts across so many different folds of biomedical science. However, this emphasizes the pervasive nature of nutrition in biology and medicine and underscores the need for integration of nutrition research within a specific unit at NIH.

I ask this committee to again address in its report the need for a nutrition division at NIH. We would like this subcommittee to assure its language requesting a division for nutrition at NIH be retained in the Labor/HHS conference report.

Finally, I would like to urge more support for clinical nutrition research facilities. To date, only seven Clinical Nutrition Research Units (CNRUS) have been established. The CNRUS conduct mission-oriented research that help implement nutrition research on a human scale.

You don't have to look far to see that we live in a health-conscious society. The billions of dollars spent every year on fad diets or the continual bombardment of commercials pushing the latest healthiest food provide plenty of evidence that Americans are concerned about what they eat. Surprisingly, and regrettably, the NIH hasn't responded with the support for nutrition research that the public interest deserves.

Basic nutrition research probably doesn't generate much constituent mail for the members of this subcommittee. But rest assured, your help in providing the funding for nutrition research through NIH will help all the people you represent. Nutrition research greatly benefits every person in this country simultaneously.

I thank you for allowing me to testify at this hearing.

NUTRITION

Senator ADAMS. Doctor, we will try to once again press as we did last year for a separate portion of NIH for nutrition. I might state to you that I will be holding hearings in an entirely separate committee on Friday, the Subcommittee on Aging of this full committee, dealing mainly with women's health problems, menopause, and osteoporosis, which we believe are directly connected with nutrition. So we will try from that direction also to move Dr. Healy and some of those at NIH to deal more with nutrition problems.

Many of us are recognizing and I think the public is recognizing-I hope it does not just become a fad-that nutrition is a basic part of preventive health, and if we can improve our nutrition, particularly for our citizens that are growing a little older and for our children, we will avoid many health problems.

I thank you for your testimony. It was excellent. We appreciate your being here.

Dr. SWAN. Thank you very much.

STATEMENT OF DR. ELLIOT VESELL, CHAIRMAN, PUBLIC AFFAIRS COMMITTEE, AMERICAN SOCIETY FOR PHARMACOLOGY AND THERAPEUTICS

Senator ADAMS. Our next testimony is from Dr. Elliot Vesell, chairman, public affairs committee, the American Society for Pharmacology and Experimental Therapeutics.

Welcome, Doctor. We welcome you to the committee this morning.

Dr. VESELL. Thank you very much, Senator Adams. I appreciate this opportunity to testify before your subcommittee.

Pharmacology is the science that deals with the actions of drugs and the discovery of new drugs. The Pharmacology Society has a membership of 4,300 scientists involved in basic and clinical research, administration, and teaching throughout the United States. Every year your subcommittee hears testimony from various groups representing hundreds of thousands of Americans who suf fer from medical conditions for which there are no currently known cures. The only hope for most of these people is basic biomedical research, the vast majority of which is funded through the National Institutes of Health and ADAMHA.

In fiscal year 1991, Congress appropriated $5.18 billion for research project grants at NIH and ADAMHA. As generous as this was, it still represents less than seven-eights of 1 percent of the total expenditure for health care. Less than 1 percent expenditure for R&D is, as Dr. Edgington pointed out, less than other industrialized countries provide. If we are ever to reduce health care costs which are astronomically high and health care needs, the answer lies with increasing basic biomedical research and specifically with increasing the financial resources devoted to investigator-initiated research project grants. This is a theme you have heard throughout the day.

Two recent studies by highly respected Battelle Institute Medical Technology Assessment and Policy Research Center demonstrate convincingly the correctness of this approach and the past savings achieved through biomedical research. They offer a glimpse of the future benefits we can expect from today's investments. The first study evaluated the human and financial benefits of some of the most important biomedical successes of the past decades. In analyzing polio, tuberculosis, coronary heart disease, and cerebral vascular disease, the study found that the products of pharmacological research alone affected the lives of more than 1.6 million people and saved close to $141 billion. In other words, it was cost effective.

For example, the study estimates that because of research success, America has avoided nearly 1 million cases of polio, 400,000 of which would have resulted in severe disabilities. Costs associated with these cases would have totaled as much as $31 billion. Funds provided to NIH and ADAMHA thus have resulted in major costs savings to the country and have saved or improved the quality of life for millions of your constituents. These investments were in basic research.

The second study makes it clear that biomedical research is at the threshold of major discoveries that will revolutionize clinical practice and affect the lives of millions of Americans and save hun

dreds of billions of dollars. The study makes it clear that the taxpayers' investment in biomedical research will continue to be a wise one. This study from Battelle estimated the number of cases and deaths that will occur in the next 10 to 25 years from five diseases alone cardiovascular, cancer, arthritis, Alzheimer's, and AIDS-taking into account demographic changes.

The study then used expert forecasting to project the impact that lifestyle changes and medical advances will have on rates of death and disease, and then it estimates the resulting economic benefit. Again, the saving was great, and I have it in the testimony so I will not go into the details here.

Over and over again it has been demonstrated that investment in basic research has major savings. With the epidemics that now exist in this country, we need to launch, I think, an Operation Health Shield. This is imperative to our own future, and it is a direct way of reducing the astronomically rising health costs.

PREPARED STATEMENT

Just think of what we would have had to put into iron lungs for polio if we were still at that stage. It would be billions and billions of expenses on new and better iron lungs. But instead, we went to basic research and solved the problem. We can do the same for AIDS, and I beg you and your committee to consider this a national emergency and to help us do the right thing.

Thank you.

[The statement follows:]

STATEMENT OF DR. ELLIOT S. VESELL

Mr. Chairman and Members of the Subcommittee:

Thank you for providing us an opportunity to testify before your Subcommittee. I am Dr. Elliot S. Vesell, Evan Pugh Professor and Chairman of the Department of Pharmacology at the Pennsylvania State University College of Medicine at the Hershey Medical Center. I am also Chairman of the Public Affairs Committee of the American Society for Pharmacology and Experimental Therapeutics (ASPET). I am accompanied by Mr. Anthony Mazzaschi, Public Affairs and Education Officer for the Society.

Pharmacology is the science of the actions of drugs and the discovery of new drugs. ASPET has a membership of more than 4,300 scientists involved in administration, basic and clinical research, and teaching throughout the United States. Pharmacologists are found in schools of medicine, nursing, and pharmacy, in private and government research laboratories, and in a wide variety of pharmaceutical and biotechnology industries. Their teaching efforts are a vital part of the formal education for the health care practitioners of tomorrow; their research efforts are crucial to the development of new medicines to fight diseases and to improve human health

According to the Health Care Financing Administration and the U.S. Department of Commerce, more than $756 billion will be spent in fiscal 1991 on health care in the United States, up over 53 percent in the past five years. Many of these health care expenditures are paid by the federal treasury through Medicare, Medicaid, and federal employee health insurance outlays. The federal deficit has clearly been exacerbated by health care costs that often appear to be out-of-control.

In analyzing the balance sheets, it is easy to forget that these health care costs are going to treat real men, women and children our relatives, neighbors, and your constituents. Every year, the Subcommittee hears testimony from various groups representing hundreds of thousands of Americans who suffer from medical conditions for which there are currently no cures. The only hope for most of these people is basic biomedical research, the vast majority of which is funded through the National Institutes of Health (NIH) and the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA).

In fiscal 1991, Congress appropriated $5.18 billion for research project grants at NIH and ADAMHA. As generous as this was, it still represents less than seven-tenths of one percent of the total expenditure for health care. If we are ever to reduce heath care costs and health care needs, the answer lies with increasing basic biomedical research and specifically with increasing the financial resources devoted to investigator-initiated research project grants. Two recent studies by the highlyrespected Battelle Institute's Medical Technology Assessment and Policy Research Center validate the past savings achieved through biomedical research and offer a glimpse of the future benefits we can expect from today's investments..

The first study evaluated the human and financial benefits of some of the most important biomedical successes of the past decades. In analyzing polio, tuberculosis, coronary heart disease and cerebrovascular disease, the study found that the products of pharmacological research alone affected the lives of more than 1.6 million people and saved close to $141 billion. For example, the study estimates that because of research success, America has avoided nearly one million cases of polio, 400,000 of which would have resulted in severe disabilities. Costs associated with these cases would have totaled as much as $31 billion dollars. Make no mistake, the funds provided to NIH and ADAMHA have resulted in major cost savings to the country and have saved or improved the quality of life for millions of your constituents.

The second study makes it clear that biomedical research is at the threshold of major discoveries that will revolutionize clinical practice, affect the lives of millions of Americans and save hundreds of billions of dollars. The study makes it clear that the taxpayers investment in biomedical research will continue to be a wise one.

The Battelle Institute's unique study estimated the number of cases and deaths that will occur in the next 10 to 25 years from five diseases (cardiovascular disease, cancer, artheritis, Alzheimer's disease, and HIV disease), taking into account demographic changes. The study then used expert forecasting to project the impact that lifestyle changes and medical advances will have on rates of death and disease and then it projects the resulting economic benefits.

The study found that over the next two decades, if advances in biomedical research are made as expected, the number of lives saved will increase dramatically and the number suffering from disabling disease will diminish significantly. For example, the study found that in the next 25 years, pharmacological intervention alone would result in a total of 150,000 prevented cases and 662,000 avoided deaths from lung cancer, colorectal cancer and leukemia; and a decrease of 2.1 million cases of both forms of arthritis. In addition, in the year 2015, there will be 439,000 fewer people with Alzheimer's disease needing nursing and home care. The study found for the diseases investigated that research has the potential of avoiding hundreds of billions of dollars in productivity losses over the next quarter century.

To achieve these and additional savings for other diseases, we must take advantage of the research opportunities that are available. Unfortunately, the success rate for research funding proposals has dropped so low that many outstanding scientific opportunities are going unexplored. It is imperative that the Subcommittee support actions to increase the success rate for investigator-initiated research project grants applications.

Although forecasting future biomedical advances is problematic, it is clear that funds appropriated to NIH and ADAMHA will more than pay for themselves. Your strong support for the critical research being conducted through NIH and ADAMHA investigatorinitiated research project grants will save thousands of lives and save billions of dollars. It's an investment worth making.

In addition to supporting Investigator-initiated research project grants we also urge your support for the Biomedical Research Support Grant (BRSG) program. The BRSG program is widely recognized as a prime source of support for innovative research ideas that are in the early stages of development. In addition to funding pilot studies, BRSG funds may provide temporary funding for research groups that are in transition. This type of support gives continuity to research projects and helps prevent expensive shutdown and startup operations. Last year, Congress appropriated $22.3 million for the BRSG program. We strongly urge you to restore the program to the fiscal year 1989 funding level of $55 million. This is a wise investment that helps stretch the value of investigator-initiated research project grants.

Lastly, we urge the Subcommittee to strongly support the training programs at both NIH and ADAMHA. The continued excellence of the nation's biomedical research enterprise is critically dependent on the vitality of NIH and ADAMHA's training grant programs. Increased opportunities in the pharmaceutical and biotechnology industries, the rapid aging of academic scientific faculty and the need to recruit more women and minorities into science demand that NIH and ADAMHA's training efforts be strengthened.

Providing strong financial support for biomedical research is a sound investment in America's future. We urge the Subcommittee to continue America's strong commitment to biomedical research. To do less than our best is unacceptable. Our nation can afford to do more. It is up to the Subcommittee to meet the challenge.