IMPACT OF PROPOSED BUDGET ON HEALTH

RESEARCH

FRIDAY, APRIL 11, 1986

U.S. SENATE,

SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS,

Washington, DC.

The subcommittee met at 9:11 a.m., in room SD-116, Dirksen Senate Office Building, Hon. Lowell P. Weicker, Jr. (chairman) presiding. Present: Senators Weicker, Hatfield, Specter, and Inouye.

NONDEPARTMENTAL WITNESSES

STATEMENT OF DR. SAMUEL THIER, PRESIDENT OF THE INSTITUTE OF MEDICINE, NATIONAL ACADEMY OF SCIENCES

Senator WEICKER. This morning, the subcommittee will hear testimony from eight highly distinguished members of the biomedical research community. I have called this special hearing because I am deeply concerned about the impact of the President's budget cuts on biomedical research.

The President's 1987 budget request for the National Institutes of Health is $400 million less than what Congress appropriated in 1986. The President's request is a full $800 million less than what NIH tells us it needs in 1987 to continue its current level of research effort.

The administration claims its proposed cuts will result in savings for the year 1987, but there are no savings to be achieved by cutting the NIH budget.

The cost of such budget cuts in the out years will be enormous and we cannot afford it either in the dollars it will cost us or in the lives of those whose pain and suffering and even death could have been avoided.

When the Senate turns to consideration of the fiscal year 1987 budget, I intend to offer an amendment to restore funding for biomedical research. My amendment will also restore the drastic cuts, and in some cases the total elimination of the Federal programs which help educate and train our nurses, doctors, and other health professionals.

Surely in a budget which can afford $43 billion for research and development in defense, we can afford $6 billion for the research that will lead to cures for cancer, acquired immune deficiency syndrome

(1)

[AIDS], Alzheimer's disease, mental illness, and a whole host of diseases and conditions we are faced with today.

It is truly my pleasure to welcome each of the scientists who have come this morning to discuss the impact of the proposed budget cuts on biomedical research. All eight panelists are well recognized for their enormous contributions in the field of biomedical research.

Dr. Roger Guillemin is a Nobel Prize winner and currently at the Salk Institute. Dr. Samuel Thier is president of the Institute of Medicine [IOM] of the National Academy of Sciences. Dr. Robert Butler, winner of the Pulitzer Prize, is former Director of the National Institute on Aging. Dr. Theodore Cooper, formerly Assistant Secretary of Health, is now vice chairman of the board of the Upjohn Co. Dr. Kenneth Shine is president-elect of the American Heart Association, and deandesignate of the UCLA Medical School.

Dr. John Durant is president of the Fox Chase Cancer Center. Dr. Herbert Pardes is chairman of the Department of Psychiatry at Columbia University, and a former Director of the National Institute of Mental Health. Dr. George Palade is a winner of the Nobel Prize for Medicine, and the 1986 Presidential Medal for Science.

We have divided the group into two panels. The first panel will be Dr. Guillemin, Dr. Thier, Dr. Butler, and Dr. Cooper.

Let me again thank you all for taking of your very busy schedules to come down here and testify before the committee. I can't think of anything more important to this Nation than what is under discussion here this morning. Maybe it is that the Nation will start to listen to those that have the expertise and the commitment in the business of life.

I just want to alert everybody that we are going to be voting during the course of this session, unfortunately. Usually on Friday, we don't have votes, certainly not in the morning. It is going to be the case, and it is going to be a little bit disruptive. I apologize for that, but there is nothing to be done about it.

I would suggest again that everybody's prepared statement, in its entirety, will be included in the record. Having made that opening statement, it is just a great pleasure for me to be here with all of you, and to listen.

Do you have some batting order, or is Dr. Thier going to lead it off? Dr. THIER. I am Dr. Samuel Thier, president of the Institute of Medicine at the National Academy of Sciences, and I welcome this opportunity to testify on the budget of the NIH for fiscal year 1987.

All budget discussions these days are necessarily conducted in the context of concern about the deficit, and although that concern is well placed, it should be joined by concern about the long-term economic and human costs of budget shaping actions based on arbitrary formulas or inadequate analysis.

The NIH budget proposed for fiscal year 1987 reduces expenditures in actual as well as constant dollars. Informed of the constraints necessary on next year's spending, NIH has replied with the utmost. It has sought to maximize scientific productivity by emphasizing funding of

individual grant proposals and establishing a new criterion of stabilized support, the maintenance of at least 18,000 grants at any time.

That strategy, however, was at the expense of the average amount of funding per grant, the number of research centers funded, the number of trainees supported, and the extent to which NIH can improve university flexibility, administrative support, and facility.

I might differ with some of the priorities chosen by the NIH, but they have made a credible response to what I view as stringent constraints. My concern is whether the constraints themselves are prudent.

The NIH is the primary source of support for basic biomedical research in the United States. The responsible conduct of research has been accepted in our society as innately good. It is a reflection of modern man's inquisitiveness and creativity, and it is also recognized as essential for a technologically advanced society like ours to continue its advances and maintain its competitiveness.

Basic research by definition does not make a product that can be used to support it. This has been recognized in the past both by the legislative and the executive branches of Government in their funding decisions. Even next year's budget in research in areas other than biomedical attests to that understanding. Why then is the NIH budget reduced?

A budget for the conduct of basic biomedical research could responsibly be reduced if the goals of that research are no longer valued as highly, if the return on past investment is felt to be inadequate, if there is too little promise of return on investment in the future, or if the research enterprise is inefficient or mismanaged. If none of these criteria are met, it seems fair to assume that the budget reductions primarily reflect an attempt to save money in the short run.

Saving money in a time of budget deficits is prudent unless there is good reason to believe that the long-range losses from the lack of investment far outweigh the short-term savings.

Looking at those criteria, surely the value of the research conducted by the NIH cannot be assumed to be less than that in the other basic sciences. Is the Federal Government now to diminish its commitment to research that contributes to improving the quality of life, reducing the burden of illness, preventing disease, and extending life span? I certainly hope not.

Funding could not reasonably have been reduced because the NIH investment has failed to pay adequate dividends-the prevention of polio and hepatitis, the reduction of infant mortality, improvement in cancer survival, and reductions in deaths from coronary heart disease, are only a few examples to the contrary. In the long run, such research saves both lives and money. Even the advancing medical technology being blamed for higher costs of care may produce savings.

The NIH budget could be reduced if the opportunities for future research payoffs seem less promising. But there is no reason to believe that payoffs of research supported by NIH will dwindle. The opportunity for biomedical research has never been greater.

The neurosciences have new insights into muscular dystrophy, the treatment of multiple sclerosis, brain and spinal cord regeneration, and even transplantation of brain tissue. Studies of the oncogenes have enormous potential for the diagnosis of cancer, the assessment of environmental triggers of malignancy and, hopefully, the ultimate understanding of malignancy.

Diabetes mellitus is yielding to new insights, some provided by modern immunology, and the field of immunology itself is exploding. Advances in molecular biology promise that gene therapy will be a reality in the near future. All of these and more contribute to knowledge pressingly needed to meet the challenges of our aging population. If any further evidence of the value of pure basic research and its future promise were necessary, we need only look at AIDS. NIH-funded scientists identified the causative virus of the acquired immune deficiency syndrome in an amazingly short time after the disease was first recognized.

Our ability to define the causative agent and to diagnose exposure to it form the basis for attempts to control and prevent the disease. The basic insights upon which AIDS research is founded were the products of pure basic research conducted at a time when the disease AIDS was totally unknown.

Another more general consequence of NIH research is that it, as a byproduct of its mission, has spawned the swiftly growing biotechnology industry.

Basic biomedical research can be an expensive undertaking. Yet the NIH has established a record of prudent management of resources that should draw particularly loud plaudits in these times of fiscal worry. A study by the Institute Committee, 2 years ago, concluded that “none of the research organizations we investigated in the United States or abroad has a more effective structure for mobilizing scientific research against disease."

What I have just presented should be cause for great concern. Here is an organization carrying out the wishes of its constituency, scoring successes and appearing likely to have even greater success in the future, improving the well-being of humanity, and managing its enterprise well. A reduction in the budget of NIH can only be seen as a short-term deficit-reducing act with enormous long-term risks. Such action is hard to defend.

What conclusion can I reach?

The budget should enable not only stabilization of investigator research grants, but should also permit the development of a balanced portfolio, including, for example, the proper number of categorical centers needed to capitalize on otherwise uncoordinated research observations.

The budget should take into account the entire enterprise can come to a halt if there are no new investigators to provide innovative ideas. NIH should be able to determine which mechanisms of support are most efficient and productive in training investigators, but the required flexibility is not in the proposed budget.