leges, and three black males from historically black universities. Since college faculty are paid $7,000 for a two-month period, and high school teachers receive approximately $2,000 per month, the estimated cost of this year's effort is $75,000-80,000. The additional costs of summer students working on research projects at the NIEHS should be similar to that incurred last year. LEAD Mr. STOKES. Now, as you know, Doctor, an alarming number of children are being exposed to lead. Research programs conducted and supported by your Institute have resulted in some new findings in reference to the characterization of the relationship between iron deficiency and lead absorption. Can you tell us what some of your recent findings are in reference to this relationship? Dr. HOEL. What we have found is that immunodeficiency increases lead absorption. The new work we would like to be doing in this area is to see if, through improved nutrition, including iron, calcium, vitamins, protein and so on, we are able to lessen the effects of lead toxicity on the neurobehavioral system, and this would be both, in children and with regard to the effects on the fetus from lead in the mother. We have current research that we are beginning in Canada and Australia where we are very much interested in the source of lead to the fetus, whether it is from redistribution from the bones of the mother or from the current intake, and so on. So, we need to develop that area. INFANT MORTALITY Mr. STOKES. Now, Doctor, we hear a lot about infant mortality these days, particularly the disparity in terms of black children who die in relationship to white children during the first year of birth, and so forth. Do environmental hazards affect the infant mortality situation or impact it at all? Dr. HOEL. I certainly believe they would, just take simply the issue of lead. I do not know for a fact that we have increased mortality due to lead, but what is equally of concern is the loss of intellectual capability of the child. Here, as I say, we need to improve our programs also in terms of treatment. We have been supporting some work with regard to chelation of lead. And we would like to see these methods brought, or become applicable to younger children who aren't necessarily at the very high levels of lead, but ones where we could come in and work and lower their levels so that they would have improved neurobehavioral capabilities. Mr. STOKES. Are you doing any studies at all in this area? Mr. STOKES. Are you doing any studies at all in this area? Dr. HOEL. Yes. We have support at Columbia through Professor Graziano and his work with DMSA. We have another study with EDTA, and this is by Professor Rosen at Montifiore. MINORITY HEALTH Mr. STOKES. Doctor, there is some thought coming out of the 1985 evaluation of the disparity between health between black and white Americans that came out of the Heckler Report. Some persons contend that some of the disparity, particularly for inner city residents, particularly minorities, can be attributed to the greater risks resulting from the location of hazardous waste sites in their communities, working conditions in industry, air pollution and other environmental conditions. Do you have any thoughts on that subject at all? Dr. HOEL. I agree entirely. As I say, much of our program-even our studies of pesticides, of the people that are exposed, both in the formulation and in the application in the fields of these potentially toxic agents, and within the cities themselves, the levels of air pollution, the amount of exposure to metals, and the lack, I would say, of good nutrition and medical care all contribute to increased mortality and morbidity in poor minority groups. Mr. STOKES. Thank you very much, Dr. Hoel. TRAINING Mr. EARLY. Thank you, Mr. Chairman. Dr. Hoel, I had to attend another meeting this morning, so I apologize for missing part of the hearing. I understand that Mr. Pursell brought up the Clean Air Act and air pollutants, so I am not going to go over that again. As far as education and training for the health care providers is concerned, is there enough money in this budget request to do that to the degree you would like to see us do that? Dr. HOEL. I would like to see increases, particularly in our new program of the academic physician awards of which I mentioned eight are to be awarded. We could have awarded more this year. Mr. EARLY. Would you, for the record, expand on what we should be doing to get the most for our money in this area? It's important that we train the providers, with foresight, so that we don't have another asbestos problem. Dr. HOEL. Yes. I think one of the best opportunities we have is to establish a consciousness of environmental-occupational health in the medical schools so that the next generation of practicing physicians is aware of these problems, and then can deliver this knowledge to their practices.. [The information follows:] EDUCATION AND TRAINING We are trying a two-edged approach. Through the academic awards I described before, we are more rigorously inculcating environmental/occupational medicine consciousness into the training of medical students and residents at the eight medical schools where we were able to fund awards. We are excited about the impact such programs will have and the high level of interest in them from medical schools throughout the country. Last year, which was the first year we announced the award, we received applications from 32 medical schools. We are also concerned that we attract more new physicians into research and teaching careers in environmental/occupational medicine. One of the best ways of accomplishing this is to expose medical students to research in the environmental health sciences. To this end, we are funding short-term research training fellowships for medical students at ten medical schools and hope to extend this program to more medical schools. Mr. EARLY. The next witness is the Director of the Aging Institute. It was only a few years ago that we didn't teach geriatrics in medical schools. They have corrected that. Mr. Chairman, I will catch up. Mr. NATCHER. Okay, fine. Dr. Hoel, we want to thank you and your associates for appearing before our committee at this time on behalf of your budget request for the fiscal year 1992. It has been a good hearing, Dr. Hoel. In fact, Dr. Raub, all of our hearings are good. I want you to know it. We appreciate it. You know, it is a pleasure to sit on this subcommittee and have the National Institutes of Health appear. A lot of able people. You people know what you are doing. We appreciate it, and thank you very much. Dr. HOEL. Thank you. [The following questions were submitted to be answered for the record:] TOXICOLOGY TESTING Mr. Natcher: In the past, you have relied on various agencies to nominate potential substances for testing. Are you moving to a more directed approach for choosing substances to test? Dr. Hoel: A recent study by the National Research Council of the toxicity testing needs of over 65,000 substances in our environment to which there is known or anticipated human exposure revealed that adequate studies for health hazard assessment were available for only 5% of food additives, 10% of pesticides, 2% of cosmetics, and 18% of the drugs. To identify priority chemicals for study, the National Toxicology Program's nomination and selection process does rely primarily on the needs and priorities of relevant Federal regulatory and research agencies as well as national public health needs. This process insures an interagency review, public input, public review by the outside Board of Scientific Counselors and final selection by an Executive Committee composed of the heads of the relevant Federal health and regulatory agencies. We have also initiated additional mechanisms to identify priority chemicals. An example of this would be the establishment of expert workgroups to identify priority chemicals for study. In response to a recent Congressional request to initiate studies on farm chemicals, we have established an agricultural chemical expert workgroup made up of representatives from academia, Federal and state government, and private consultants. These individuals are experts in farm chemicals, their use, potential exposure, and the toxicity associated with their use. It is the charge of this workgroup to develop a list of the highest priority farm chemicals having gaps in knowledge concerning their toxicity and what studies need to be performed to fill these gaps. Another area that holds promise in identifying priority chemicals is the use of computer assisted structure activity studies which use the actual chemical structure to evaluate a substance's potential to cause a toxic response. These studies are based on the results of previous toxicity studies of chemicals with similar structures and will assist us in selecting better candidate chemicals for study. Mr. Natcher: Can any of your toxicology testing be financed through your Superfund resources? Dr. Hoel: In addition, the two primary NIEHS superfund programs are specifically described in the law. The first is a program of basic research and research training to be conducted through grants to universities. The second is a training program designed to teach laborers, emergency response personnel, and heavy equipment operators how to protect themselves from exposure during hazardous waste cleanup, emergency response, or transportation. There are provisions in the Superfund legislation for conducting toxicology tests of the most hazardous substances found in abandoned hazardous waste disposal sites. The Agency for Toxic Substances and Disease Registry (ATSDR) and the EPA are given principal responsibility for this activity in the Superfund law. However, since NIEHS has the technical capacity for conducting such tests, we entered into an interagency agreement with ATSDR to test chemicals for ATSDR and EPA. We have been doing this work since 1982. About 80 compounds have been evaluated in short-term tests and 21 of these substances are currently being tested in longer term studies. Under this program, NIEHS conducted the first toxicologic study of the effects of a complex mixture of chemicals commonly found in contaminated ground water with funding support from the ATSDR Superfund resources. Today, several such mixtures studies are being conducted by NIEHS using funds transferred from ATSDR. DISSEMINATION OF INFORMATION Mr. Natcher: How much are you budgeting for the dissemination of information to the general public about the health risks of certain substances? Dr. Hoel: Health risks of substances in our environment are evaluated by the Institute's Division of Toxicology Research and Testing, the main arm of the National Toxicology Program (NTP). Approximately $1 million, or 1% of the NTP budget, is spent annually for the preparation, printing and mailing of information. This does not include the dissemination of the findings of the Institute's in-house and university-based basic and applied research programs. The primary clientele for this knowledge are the scientific and medical communities and the regulators. These findings are published in the peer reviewed scientific literature and presented at scientific conferences and meetings. Efforts to communicate this knowledge to schools, colleges and universities, and the general public are increasing. CLEAN AIR ACT Mr. Natcher: Provide a detailed list of the new mandates and authorizations for your Institute included in the 1990 Clean Air Act. Dr. Hoel: The 1990 Clean Air Act charges NIEHS with conducting a program of basic research to identify, characterize, and quantify risks to human health from air pollutants. The Act specifies that this research be conducted through university and medical-school grants, as well as through intramural studies and contracts. Additionally, the NIEHS is to conduct a program for the education and training of physicians in environmental health. The Act also asks that NIEHS support research to help determine threshold levels of mercury below which adverse human health effects would not occur. To ensure coordination between the basic research provided by NIEHS and the applied research provided by other federal agencies, the Clean Air Act of 1990 places NIEHS on two interagency committees the Scientific Advisory Panel for the Mickey Leland Urban Air Toxics Research Center and the Interagency Task Force to Coordinate Environmental Health Effects Research. Mr. Natcher: REIMBURSABLES Break out the sources of anticipated reimbursables in 1992. Dr. Hoel: The anticipated sources of FY 1992 reimbursables are as follows. 43-264 0-91-2 |