strategies to reach the black population, since blacks in the Stroke Belt are twice as likely to die of stroke as whites in that region. Smoking education activities have continued the theme of "clinical opportunity," developing tools to help health professionals more effectively intervene with patients who smoke. Using this theme, a new guidebook was produced for respiratory care therapists, and a training videotape was developed for physicians. In addition to its cardiovascular-related programs, OPEC operates the National Blood Resource Education Program, composed of major national blood-related voluntary and professional organizations. Recent efforts in this program include production of two major reports providing guidance for health professionals -one on use of red blood cells, platelets and fresh frozen plasma and the other on the use of autologous blood. ago. A new national education program was launched just one year The National Asthma Education Program was begun in recognition of the growing prevalence of asthma in the U.S. and increasing mortality. The program is working on production of definitive guidelines for asthma diagnosis and treatment for physicians and other health professionals. Question. FY 91? What new initiatives do you plan to undertake in Answer. In FY 91, many of OPEC's current activities will be continued and intensified, and the possibility of new programs will be explored. For example, the asthma program has initiated a collaborative effort with the Department of Education to reach school administrative and health personnel. Broader collaboration in school health education is being considered for FY 91, especially in light of new recommendations on cholesterol-lowering in children and adolescents. In addition, NHLBI is analyzing the feasibility of starting a National Heart Attack Alert Program, focusing on the rapid identification and treatment of heart attack victims, with the goal of reducing morbidity and mortality. Question. How much funding is included in the budget for education and prevention in FY 91? Answer. The 1991 estimated level of funding for NHLBI's education and prevention programs is $6,056,000. Question. How does this compare to FY 89 and FY 90? Answer. The 1989 actual level of obligations for NHLBI's education and prevention programs was $7,341,000 and the estimated level for 1990 is $5,736,000 before reprogramming. NATIONAL INSTITUTE OF DENTAL RESEARCH STATEMENT OF HARALD LÖE, DIRECTOR BUDGET REQUEST Senator HARKIN. Next, Dr. Harald Löe, Director of the National Institute of Dental Research. And you want $140.52 million, that is 3.52 percent is what I have. Dr. LöE. Thank you very much, Mr. Chairman. Last year, I reported on the dramatic improvement in dental and oral health of America's children and young adults. And I also said that the reduction in the disease in these cohorts amounted to a saving in the Nation's dental bill of approximately $3 billion to $4 billion per year. That was my good news. The bad news was that older Americans were not doing well at all: That approximately 50 percent of the older segment of the population had lost all their teeth, and that those who still had teeth experienced the most tooth decay and the most severe periodontal diseases. One of our initiatives during the 1990's will be to capitalize on the successes that we have had in the young and decisively address the problems of the aged. Our goal is to eliminate toothlessness in this country, and to put an end to the pain and the misery from oral disease among our senior citizens. Our other major initiative relates to the so-called special care patients. These are people of all ages who have been victims of genetically determined diseases or congenital disorders. Examples are cleft lip and cleft palate; ectodermal dysplasias, where children are born with misshapen or missing teeth; osteogenesis imperfecta, which is another word for brittle bone disease. Other patient categories are those with autoimmune diseases. We have 4 million Americans suffering from Sjögren's syndrome, and other thousands suffering from canker sores, as we discussed last year. A third group are those suffering from systemic diseases that, in various ways, reflect on the well-being of the mouth. The most prominent group here would be diabetic patients. Both juvenile and adult-onset diabetes have serious impacts on oral health, increasing susceptibility to periodontal diseases and other diseases affecting the mouth and the teeth. Various blood diseases are also included in this category. The last group that I will mention are all the patients treated for cancer by radiation or by chemotherapy. Both these treatments can have devastating effects on the oral cavity. Mr. Chairman, most people think of the NIDR as a two-disease institute: cavities and periodontal disease. This is a great miscon ception. It is true that our institute is special in that we deal with problems of all 250 million Americans. PREPARED STATEMENT We have shown you what we can do with tooth decay and periodontal disease; with your support, we look forward to showing you what we can do for the millions of special care patients and highrisk groups that are addressed in our initiatives. Our request for 1990 is, as you said, $140,520,000, and I will be happy to answer any questions that you may have. Thank you. [The statement follows:] STATEMENT OF DR. HARALD LÖE Mr. Chairman, the National Institute of Dental Research is beginning the decade of the 1990's with a new Long-Range Research Plan that will take us to the year 2000. The new plan, available later this Spring, establishes two major initiatives that have become high priorities for the Institute. The first initiative reflects our concern for "special care" patients. These are people whose oral health is affected by systemic diseases or systemic treatments. We are talking about Americans with such well-known conditions as diabetes, cystic fibrosis, lupus, and AIDS, as well as patients with rare or so-called "orphan" diseases such as scleroderma, a disease in which skin and connective tissue harden and shrink, leading to limited mouth opening; osteogenesis and dentinogenesis imperfecta, in which bones and teeth are poorly developed and subject to fracture; the ectodermal dysplasias, in which essential components of skin and teeth fail to develop properly; and Sjögren's syndrome, a condition of dry eyes and dry mouth, often complicated by arthritis, that primarily affects women. Sjögren's syndrome may not be so rare, since recent estimates suggest that up to 2 million Americans may be affected. We would also include among special care patients individuals who have suffered oral complications because of cancer chemotherapy or radiation to the head or neck. In addition we intend to expand research on a number of primary oral conditions that merit increased attention such as oral cancers, certain chronic facial pain conditions, and disorders of taste and smell. All told, special care patients add up to millions of Americans. We have been alerted to their needs because the patients and their families themselves have formed organizations to address those needs and because their health problems are increasingly coming under research attack by NIDR-supported scientists. Indeed, we foresee a time when dentists in America may be the primary point of entry into the health care system for many people, providing diagnosis as well as treatments or referrals for many of these conditions. I can illustrate that broadening of the scope of the dentist with an account of what happened recently during a visit by a Congressman to a dental clinic affiliated with one of the country's leading dental schools. The delegation had stopped to observe a dental examination in progress in which the dentist had noted a spot on the tongue of the patient. Later, the Dean of the dental school, who had also observed the patient, confided that while positive test results would be needed to confirm the diagnosis, the patient almost certainly had Kaposi's sarcoma and that this sign may well have been the first indication that the patient, a young man, was infected with the AIDS virus. The AIDS epidemic is a good example of the extent to which oral health research has expanded to include the full range of diseases and disorders that affect the oral tissues. In our new Long-Range Research Plan we use the phrase "from AIDS to Xerostomia" (the technical term for dry mouth) to express this broadened capability. Recent indicators of our progress include: The development of an animal model for osteogenesis imperfecta and isolation of the genes for major bone growth factors involved in bone and joint diseases. These studies may lead to the use of specific growth factors to reverse the connective tissue damage that is seen, for example, in osteoarthritis. O Use of the drug pilocarpine to treat Sjögren's syndrome Development of sensitive tests indicating that human papil- O Clinical studies of the use of permanent dental implants Development of experimental models of chronic pain due to nerve injury (neuropathy). An unexpected finding was considerable spontaneous nerve activity in the damaged nerves. This could account for the heightened sensitivity and severity of pain experienced by patients with diabetic neuropathy and other forms of neuropathy. In terms of progress in AIDS research, I would add: Continued evidence that oral signs and symptoms may be the Issuance of a Request for Applications to explore the role Refinements in transgenic mouse models of HIV. In collaboration with the National Institute of Allergy and Infectious Diseases, NIDR scientists have inserted individual HIV genes |