older have the most severe oral health problems of any age group. Given this, does the budget for FY 1991 include sufficient funding to implement this "major initiative"? How much is included in the FY 1991 budget to support research into the oral health of older Americans? How does this compare to funds spent in FY 1989 and 1990?

Answer. Strictly defined, research related to the oral health of older Americans is estimated to be $5.9 million for FY 1991, compared to $5.5 million in FY 1989 and $5.7 million estimated for FY 1990. The Research and Action Program comprises more than agingrelated research, however. Our intent is to address the oral health problems of adults as a whole, with particular attention to those at risk for tooth loss for reasons of health or socioeconomic factors. If we include clinical research on such adult oral health problems as periodontal diseases, root caries, primary and recurrent coronal caries, and add in epidemiologic studies and models of tooth loss, the amount expended for the Research and Action Program was close to $15 million in FY 1989. Similar expenditures are anticipated for FY 1990 and 1991. In order to maintain this level of support, the NIDR will encourage research applications through the use of program announcements, requests for applications, and requests for proposals.

FLUORIDE STUDY

Question. Dr. Loe, what conclusions can be drawn from the recently reported National Institute on Environmental Health Sciences study concerning fluoride? How should I respond to my constituents in Pennsylvania who express concern about this report?

Answer. The National Toxicology Program (NTP) has released preliminary data from a study on the possibility of a relationship between sodium fluoride and cancer in rodents. The 2-year study exposed rats and mice to very high doses of sodium fluoride. This standard method enables scientists to detect rare events. At the highest levels, which greatly exceed the amount used to fluoridate drinking water, there were some cases of osteosarcoma found in Fisher rats. At this time, the data have yet to be analyzed, interpreted by experts, or subjected to peer-review by outside scientists. We are also aware of preliminary results from another 2-year rat bioassay by the Proctor and Gamble Company in which Sprague-Dawley rats received high doses of sodium fluoride in their diet. This study found no evidence of any benign or malignant bone tumors. Like the NTP study, however, the Proctor and Gamble study must still undergo scientific peer-review and publication. In short, the entire data must be fully analyzed to determine their significance. Until the completion of this process, the many benefits of fluoride warrant continuation of the present policy designed to prevent tooth decay. It should be pointed out that, after 45 years of water fluoridation involving scores of human epidemiological studies both in the United States and in other countries, there has not been any evidence that shows a relationship between fluoridation and cancer or other diseases in humans.

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

STATEMENT OF DR. ANTHONY S. FAUCI, DIRECTOR

SUMMARY STATEMENT

Senator HARKIN. Dr. Fauci, we welcome you. I see that your request is $886.88 million, for a 6.47-percent increase. Dr. Fauci, welcome. Please proceed with your statement.

Dr. FAUCI. Thank you, Mr. Chairman, Senator Bumpers.

We are living in an era of great research opportunities as well as unprecedented scientific opportunities. These opportunities are possible mainly because of advances which result from basic research.

We are currently reaping the benefits of investments in basic biomedical research of the past decade, and likewise the basic research we perform today is a critical investment in the accomplishments of tomorrow.

In particular, the rapidly evolving fields of immunology and microbiology are providing new opportunities for creative and highyielding research. NIAID scientists, for example, were quick to exploit the possibilities presented by a basic research technique called the polymerase chain reaction which selectively amplifies genetic material. This technique can detect very early HIV infection and NIAID intramural scientists have recently adopted it for use as a diagnostic test for the elusive agent of Lyme disease.

Another important accomplishment of the 1980's built on the basic research of NIAID scientists which we will see come to fruition in the 1990's is the ability to screen blood for hepatitis C virus, formerly called non-A, non-B hepatitis, the principal cause of transfusion-associated hepatitis.

In addition, molecular biological techniques have made possible new candidates for a pertussis vaccine with potentially minimal toxicities. Furthermore, recent advances in tissue typing at the molecular level, together with the development of more specific and effective immuno-suppressive regimens, may well revolutionize the field of organ transplantation in the next decade or two.

Nowhere do we have better examples of the payoffs from basic and clinical research investments than with AIDS. Results from recent studies indicate the benefits of HIV-infected individuals prior to the onset of symptoms, as well as the real possibility of an effective vaccine in the decade of the 1990's.

In a more immediate and practical application of our drug development program, we have launched our community programs for clinical research on AIDS this past year, and it promises to be quite successful in providing a clinical trial apparatus at the grassroots community level.

NIAID is in a unique position to use the emerging opportunities in biomedical research to provide the means to prevent, and even

to completely eliminate certain diseases from the United States and the world. As you know, Mr. Chairman, the toll of human life and suffering is enormous, and new and reemerging diseases continue to challenge us.

PREPARED STATEMENT

Thus, we at NIAID look to the 1990's with resolve, energy, and enthusiasm. I am confident that we can meet the challenges of the 1990's through the knowledge that we have gained, and will continue to gain, by investing in basic and clinical research in allergy, immunology, and infectious diseases.

Mr. Chairman, the fiscal year 1991 budget request for NIAID is $886,875,000. I would be pleased to answer any questions you may have.

[The statement follows:]

STATEMENT OF DR. ANTHONY S. FAUCI

We live in an era of great scientific accomplishments, but it is also an era of unprecedented emerging research opportunities. These opportunities

have been made possible in large part by advances in biotechnology and molecular biology, many of which are the fruits of NIAID-supported basic research. Without question, we are now reaping the benefits of our investment in basic research of past decades. Likewise, the basic research of today is a vital investment in the accomplishments of tomorrow.

In particular, during the decade of the 1980s, the rapidly evolving fields of immunology and microbiology have provided new opportunities for creative and high-yielding research. For example, last year I mentioned a new research technique called the polymerase chain reaction, or PCR, that uses the polymerase enzyme from a microorganism living in the warm waters of geysers and hot springs. I explained how PCR can multiply minute quantities of genetic material in a tissue sample, making it possible to detect diseasecausing microorganisms that otherwise are hidden in the human body. Researchers who were working on the microbiology and molecular biology of that unusual bacteria called Thermus aquaticus had no idea of the ultimate implications of their research.

Carried by ticks and

Over the past year, AIDS research has brought PCR to the forefront where it has been used to detect very early HIV infection. In fact, its value is much broader than AIDS diagnosis, and NIAID intramural scientists have been among the first to explore its possibilities. They have adapted PCR to a diagnostic test for the elusive agent of Lyme disease. recognized only 15 years ago, Lyme disease is now the most commonly reported arthropod-borne disease in the United States. If not treated, it can cause great pain and disability from chronic arthritic, neurologic, or cardiac symptoms. A major roadblock to effective treatment has been the lack of reliable tests to diagnose the disease during early infection. Development of a sensitive new test using PCR should greatly facilitate accurate diagnosis. Another important accomplishment of the 1980s was built on basic

research by NIAID intramural scientists. In the 1970s, they identified an agent that they called non-A non-B hepatitis virus and determined that it was the principal cause of transfusion-associated hepatitis. They characterized