Mr. MACKAY. But your priorities are about the same as the American people. You are saying, I want you all to reform, but I am going to put a little less into nutrition next year.

Dr. BRANDT. No; I don't think that is correct. I think that we have said that it is not enough to continue to do research unless people begin to use the results of that research in their own lives. Mr. MACKAY. One of the things that research could show would be that the payoff is much more dramatic than we thus far know. Dr. BRANDT. I think we have shown that. I think the data is pretty clear about that. And I think that we have carried that out through all of the agencies of the Public Health Service, including the CDC, including the FDA, and so forth, to get across to the American people what these things indicate.

As I pointed out in my testimony, we are now beginning to seeone of the problems we have had in the past has been that has been a lot of debate and controversy over the interpretation and the meaning of much of the nutrition research as it applies to individuals.

We are now beginning to see some convergence on that. The National Academy's recent report on "Diet, Nutrition, and Cancer"the guidelines that they have recommended are quite compatible with the guidelines that have come from numerous studies on the prevention of cardiovascular disease.

I have set out research right now to try to investigate the recommendations that came out of the National Academy's report.

So that we are following up on these kinds of activities. Our objective is to try to get as much information as we possibly can that will allow us to prevent disease before it occurs. I mean, that is the only way.

I fully agree with you that this country cannot build its system, cannot afford a system, that is dependent on care of the sick. It has to somehow or other reduce the number of sick people. And the way to do that is through all of these efforts.

Our research is aimed at that. I think the kind of information that is coming in is of value and will continue to be of value.

Dr. WYNGAARDEN. Mr. MacKay, if I can add a point or two. In the last 51⁄2 years, the NIH has issued 72 different announcements designed to stimulate work in nutrition: program announcements, request for applications, and requests for proposals. These involved most of the Institutes at NIH. So that there is a concerted and continuous effort to stimulate work in areas in which special need is perceived to exist.

I would add also, that much of the nutrition work at the clinical level is very slow work. For example, the project that I mentioned in respect to end stage renal disease is estimated to be a 6-year project.

The project that the National Cancer Institute has started this year on the role of certain dietary factors and micronutrients on rates of developments of cancer may very well be an 8- or 10-year project. So that this is not a field in which there is quite as rapid a turnaround as perhaps a circumscribed laboratory-based investigation.

Dr. Brandt indicated that there was a range of costs in research and in general, nutrition projects tend to be a little less expensive.

So I would add another dimension to the answer to your question: There are 1,318 research grants and 83 program project grants in nutrition, which together are about 1,400, representing about 8 percent of all research awards in those categories.

Mr. BROWN. Mr. Skeen.

Mr. SKEEN. Thank you, Mr. Chairman.

I just want to have one quick question. It is kind of a followup with one that Mr. MacKay has asked. Has anyone got a handle from the DHHS or anyplace else on just how many governmental and nongovernment agencies are doing research on nutrition and related topics like that? Just how much money totally in the United States do we have dedicated to that?

Dr. BRANDT. We have a very good handle on Federal efforts in this. We do not have, to my knowledge, anywhere, a good compilation of research that is being done by private industry, particularly food manufacturers, food processors, and other interested organizations who carry out significant amounts of research on nutrition. Although I am sure it is available, I just don't happen to have it. Mr. SKEEN. Is it significant or is it of such a nature that it is insignificant?

Dr. BRANDT. No; I think it is significant. It is significant in a whole variety of ways, not the least of which is affecting behavior of people, that is, if you can make foods that are good for you taste good and attractive, all those kinds of things, people will eat them. I think that that kind of research is certainly important.

We also don't know how much is going on at the State levels because there are States, particularly agricultural States, that spend fair amounts of money in attempting to look at improved nutritional activities. I am sure that that information is available some place. I just don't happen to have it. We can try to find out those numbers for you and get them to you if you would like, sir.

Mr. SKEEN. I don't want to feed just an ambient or a casual interest, but I would think that if we are going to discuss what the total impact on the nutritional well-being is of the United States that somewhere along the line we ought to get some idea of just how much total dedication. If dollars are the measure, how much totally? Is the Federal Government, State governments, and the private sector involved in nutritional research? It would be very interesting.

We are obviously a country that has done very well nutritionally, in spite of ourselves. I have always kidded someone about talking about the recession. The economists ought to go to a Wendy's or a McDonald index, or Captain Ahad's, or whoever you are eating with.

It would be interesting to know just how much total involvement we have in nutritional research, because I think it is probably considerable, and maybe the Federal involvement is just a small tip of the iceberg and one that somewhere along the line I would think it would be interesting to coordinate these. They were asking you questions about how you are coordinating your activities, that it has been difficult enough in just the various-how many grants? 1,300? 1,400?

Dr. BRANDT. 1,400.

Mr. SKEEN. 1,400 grants-keeping tabs on those plus those that are not associated with any Federal activity or State government activity.

I don't want to give somebody a research project that would be insignificant. But I would think that, possibly with my contribution to the overall idea of just where we are going with this kind of research.

Dr. BRANDT. I think that you are right and that I wish that I had, frankly, gotten that information together before we got here, but I didn't.

I might say that we are only talking about HHS, too, because you have the Department of Agriculture testifying a little bit later who also gives research grants and also is involved and has nutrition centers. We know that the Veterans' Administration is heavily involved. But at the moment I don't have a handle, but we will certainly look into it and see how much information we can find, particularly about the private sector.

[The information follows:]

The Government's agenda in human nutrition research is indeed substantial. But it is not the only source of such research. Other sponsors of human nutrition research include private foundations, professional and voluntary organizations, food manufacturers and marketing institutions, the pharmaceutical and infant formula industry, commodity groups, the chemical nutrient manufacturing industry, and even, through analysis of actuarial tables, the insurance industry. A nice example of human nutrition-related research sponsored outside the government is the current large scale effort of the American Cancer Society to identify a variety of factors in cancer causation, including nutritional factors. Through our Interagency Committee on Human Nutrition Research the various Federal agencies involved in nutrition research are currently compiling inventories of current activities and plans for future activities. As we develop plans for our own efforts to meet perceived gaps we will consult with these other non-governmental partners in human nutrition research to insure that our efforts are closely coordinated.

Mr. SKEEN. I would think it would give us a better scope and I appreciate the response. It was just a curiosity of mine in listening to the testimony that we heard here this morning and the questions. I don't think that we in Congress have a real handle on what we are talking about in the way of how much dedication we have either agencywise, private sectorwise, in all levels of government, plus the private sector.

It would be very interesting also to know just how much in the way of fiscal resource is going into this sort of research.

Dr. WYNGAARDEN. I was just handed a table of total Federal expenditures for research and training in 1982 among the various departments, and it comes to $195,300,000.1

Mr. SKEEN. $195 million?

Dr. WYNGAARDEN. $195 million.

Mr. SKEEN. That is Federal only?

Dr. WYNGAARDEN. Federal only; yes, sir.

Mr. SKEEN. OK.

Thank you, Mr. Chairman.

Mr. MACKAY. Mr. Chairman, I would like to make sure I understand this.

Mr. BROWN. Mr. MacKay.

1 DHHS requested data be changed to read: $206,981,000.

Mr. MACKAY. On page 2 of your testimony, Dr. Brandt, you said that you spent $155 million.

Dr. BRANDT. That's correct.

Mr. MACKAY. Does that mean all the other agencies together, as far as you know, spend the other $40 million?

Dr. BRANDT. Yes, sir.

Mr. BROWN. Did you have another question, Mr. MacKay?
Mr. MACKAY. I would like to just ask one other question.

There is a condition that is becoming a matter of intense interest in Florida as we find ourselves more and more with an older population and people in nursing homes. And people are now becoming aware of the fact that maybe 20 to 30 percent of the female population in nursing homes are suffering from a degenerative condition of the bones. I don't even know the technical term for it.

Dr. BRANDT. Osteoporosis.

Mr. MACKAY. Osteoporosis. And that many of those persons, if they did not have that condition, would not require being in nursing homes.

Now, what are you doing about that? And is that funding going up or is that some of the funding that is being stripped away to go somewhere else?

Dr. WYNGAARDEN. Osteoporosis is one of a range of metabolic bone diseases in which we have a very intense activity. It involves calcium and phosphoros metabolism and cartilage synthesis of the protein in which the calcium and phosphoros are laid down. And that spans the entire sweep of our studies throughout the human life span.

The National Institute of Child Health and Human Development, for example, has a great deal of work going on in that area. We know that there are important hormonal influences on the process of bone turnover, on the rate of deposition of calcium, on the rate of formation of the matrix, and on the rate of its turnover in the body. Estrogen plays an important role in that process.

That whole area is one of intense interest. It overlaps also the cancer field, because there are many cancers which accelerate the rate at which bone is resorbed, and lead to skeletal problems from that cause.

I can't give you offhand a precise estimate of our budget in that area, although we could certainly find that.

I would add that in April 1984, we have a consensus conference planned through our Office of Medical Applications in Research designed to address the problem of osteoporosis and specifically to bring together the experts in this field and to issue statements of advice regarding the best management of that condition.

So it is a high priority area with us we recognize.

Mr. MACKAY. Will you tell me then, if it is high priority, if the investigators who are now funded in that field are being refunded or cut back?

Dr. WYNGAARDEN. I can't tell you that precisely. The average grant is made for 3 or 4 years, and at the end of that time the application comes in for competitive renewal. The refunding of a grant depends on the progress made during the initial phase of support and how experts in that field judge the merits of that work in comparison with other work being proposed.

A fairly high percentage of grants, once funded, have a fairly good chance of being continued if there is good progress. But there is always some turnover.

Mr. MACKAY. In your setting of priorities, then, the quandary that Mr. Brown talked about and you responded to concerning the effort to keep 5,000 investigator-initiated grants going, could that process result in the competition in these other areas becoming more keen?

Dr. WYNGAARDEN. It protects what we consider to be the most effective mechanism in the generation of new knowledge, that is, the investigator-initiated research project grant. With respect to osteoporosis, for example, many of those projects will come in, unsolicited, submitted by investigators whose field of interest is in this area. To the extent that we are protecting 5,000 new and competing awards we are protecting that kind of scientist. But as indicated earlier, some of the centers where work of this sort might also be going on will be facing stiffer competition as a result of that policy decision.

Mr. MACKAY. Is that policy decision, then, a result of a conclusion on your part that the centers are a less effective way of achieving medical knowledge than investigator initiated?

Dr. WYNGAARDEN. Only slightly less. We have to establish priorities to decide which we will protect in a constrained budget.

Mr. MACKAY. Do you need the Congress to say to you as a matter of policy, we want you to put a greater percentage of your effort into nutrition research?

I am not trying to ask editorially. I am just trying to find out how the system works. Are we entitled to look to you as the person who is setting the policy?

Dr. WYNGAARDEN. We do believe that the aspect of a freedom that is inherent in the American scientific system is best preserved by a minimum of direction from us, from the administration, and from the Congress in terms of micromanagement under the system because priorities will change, opportunities will change. If we get locked into directives, we find ourselves with less opportunity to respond to needs as they arise on the basis of scientific progress.

Mr. MACKAY. Then where would be the standard by which we would hold you accountable?

Dr. WYNGAARDEN. We are held accountable in terms of the output of American science and the influence that that has on the health of the American people. And there are many indices of that. Mr. MACKAY. How would the American people say to you that we think 42 percent, or if it is 8 percent, is not an appropriate set of priorities?

Dr. WYNGAARDEN. We have that kind of presentation at the budget hearings and with streams of people through my office. Everybody has a higher priority for his or her own disease area. There are literally thousands of named diseases. There are literally hundreds of societies that are interested in a particular disease.

I think that their interests are best served by providing the resources as the Congress and administration have done for several decades now, and then allowing the peer judgment of the scientists a great deal of latitude in deciding where the greatest opportunities really do rest.