GOVERNMENT. THE UNIVERSITIES NEED SOME FLEXIBILITY IN MANAGING COMPLEX RESEARCH PROJECTS. YET THE PROPOSED NIH BUDGET WOULD REDUCE THE BIOMEDICAL RESEARCH SUPPORT GRANTS PROVIDED TO UNIVERSITIES. IT WOULD PERPETUATE THE GOVERNMENT'S PROPOSAL TO LIMIT PAYMENT FOR INDIRECT COSTS OF RESEARCH WITHOUT INVOKING THE COMPLEMENTARY RECOMMENDATIONS OF THE WHITE HOUSE SCIENCE COUNCIL PANEL. IT WOULD REDUCE TO ZERO CONSTRUCTION FUNDS ASSOCIATED WITH RESEARCH PROJECTS. THE BIOMEDICAL RESEARCH LABORATORIES AND EQUIPMENT OF UNIVERSITIES ARE IN NEED OF REPAIR AND REPLACEMENT: TO BUDGET FOR NO IMPROVEMENTS IN FACILITIES OR EQUIPMENT IN FY 1987 DOES NOT SEEM A SENSIBLE INVESTMENT POLICY.

IN SUMMARY, THE NIH BUDGET STRIKES ME AS INCONSISTENT WITH THE FEDERAL GOVERNMENT'S EXPRESSED COMMITMENTS TO THE SUPPORT OF BASIC RESEARCH. THE PARTICULAR VALUE OF BASIC BIOMEDICAL RESEARCH, WITH ITS IMPLICATIONS FOR HEALTH AND FOR THE CONTROL OF HEALTH CARE COSTS, MAKES A COMPELLING ARGUMENT AGAINST CUTTING THE NIH BUDGET. IT IS HARD TO UNDERSTAND WHO IS SERVED BY ITS CONSTRICTION. IF YOUR CONCLUSION IS AS MINE, THAT NO ONE IS WELL SERVED. I WOULD, RESPECTFULLY ENCOURAGE YOU TO RESTORE THE NIH BUDGET AT LEAST TO PARITY WITH THE REST OF THE INVESTMENT IN DEFENSE AND NONDEFENSE BASIC SCIENCES DESCRIBED IN THE 1987 BUDGET. IF YOU FEEL THAT POTENTIAL PAYBACK ON INVESTMENT IN THE NIH IS LIKELY TO EXCEED THE INVESTMENT ITSELF--AS IT HAS DONE HISTORICALLY--THEN I WOULD ENCOURAGE YOU TO CONSIDER ADDITIONAL SUPPORT.

I WOULD BE PLEASED TO RESPOND TO ANY QUESTIONS YOU MAY HAVE.

STATEMENT OF ROBERT N. BUTLER, M.D., PULITZER PRIZE WINNER AND FORMER DIRECTOR, NATIONAL INSTITUTE ON AGING

Senator WEICKER. Dr. Butler.

Dr. BUTLER. What I would like to do is submit for the record my more formal statement, and highlight some of the key issues, as I see them, from the perspective of science at large, biomedical research, and specifically aging research.

It is, in fact, a minimal position that I presented to you in the formal statement. NIA, the National Institute on Aging, has never been adequately capitalized, having come into being right after the Organization of Petroleum Exporting Countries [OPEC] price rises, and in a sense, it is now being decapitated, yet this is a period of time in which we must address the fundamental biological processes of aging, and particularly focus upon that most devastating of conditions, senile dementia of the Alzheimer's type, perhaps the No. 4 cause of death.

In fact, as a society, we have not adequately prepared for the longevity revolution. This extraordinary increase in less than a century, a gain of 25 years in life expectancy is nearly equal to what had been attained the preceding 5,000 years, something that we should feel very proud of. Yet, neither the private sector nor Government has responded adequately to it. We are losing many opportunities.

In 2030, which is after all just tomorrow, the baby boomers, born between 1946 and 1964, will by then constitute 21 percent of the population, which means that 21 percent of the population will be 65 and above, and will be made up by the baby boomers. The health costs associated with that group will be at least in excess of 50 percent.

The fear of losing one's mind, of losing one's independence, and having to go into a nursing home, is one of the most critical spectres that haunts people throughout their lives, and it becomes increasingly so as people grow older.

Today, the estimates are that we have about 2 million people suffering from senile dementia of Alzheimer's type, the costs being perhaps in the range of $38 billion in direct costs. But imagine 2050, when it is anticipated that we will have 9 million people with senile dementia of the Alzheimer's type, if there are not breakthroughs, that would cost us some $180 billion in direct costs, which is nearly equal to the present budget deficit.

Two of the great causes of death, as Dr. Thier pointed out, have been dramatically reduced in terms of deaths, death from stroke and death. from heart disease. That reflects in no small measure the success of NIH. But we have not completed the task of understanding better cardiovascular disease, circulatory disease, and we certainly have before us the important problems of Alzheimer's disease and cancer.

It is clear that aging is one of the three great antecedents of disease, along with genetics and environment broadly defined, and yet we have spent so little energy, money, resources in studying the fundamental processes of aging. The 85-plus age group is now the fastest growing age group in all of the industrialized world. Some 24 percent of people over 85 reside in nursing homes.

Clearly we must solve this problem of Alzheimer's disease, and if we do, we will empty one-half of the nursing home beds in this country, one-half. I think of the nursing home as the iron lung of geriatrics, and I would remind us that our last polio epidemic was in 1961, just 25 years ago, that we no longer have a significant array of tuberculosis [TB] sanatoria. In short, biomedical research can make a successful effort.

Now we must also think in the broadest terms about biomedical science. We must refocus our energy upon research training, after all the life-blood of science. In fact, we really have to think about science education in public and private schools. We have to also focus upon the training of people in the field of geriatrics.

Despite the fact that we spent last year $2 billion in Medicare money for graduate medical education, really none of it was devoted to training in geriatrics. In this country, we have about 100 geriatrics fellowships, period, training people to become the leaders, the researchers, the innovators in health delivery to older people.

I am not talking about a new practicing specialty in geriatrics, I am talking about academic leadership. In the first 22 years of existence of the Heart Institute, it was able to train 16,000 people in cardiology, just to give you a standard against which to compare that small group of 100 geriatric fellowships.

To bring us to a conclusion, one of the most disturbing facts for so many of us, I believe, is the erosion of the science base in our country, of the science infrastructure, of the training of young people, of the creation of support for biotechnology and high technology, the loss of flexibility at NIH in pursuing many opportunities, to conduct clinical trials, to build critical resources through centers.

I personally believe that one of the key groups to look at in terms of the problem of aging are the baby boomers. The first baby boomer turned 40 somewhere about 1 second after midnight on January 1 of this year. That means the baby boomers, the largest generation in U.S. history, are beginning to appreciate the problems of their parents and their grandparents, who are now well into their sixties and eighties.

But I submit that we can't wait until 2020, when the baby boomers reach golden pond to begin to find options to nursing home care, to train academic geriatricians, to find the solution to Alzheimer's disease, and to look at the many other tremendously disturbing maladies of late life.

Thank you.

PREPARED STATEMENT

Senator WEICKER. Thank you, Dr. Butler. We will insert your statement in the record at this point.

[The statement follows:]

STATEMENT OF DR. ROBERT N. BUTLER

Mr. Chairman and Members of the Committee, I am Dr. Robert N. Butler. I am pleased to testify before you from a perspective that is somewhat unique. I served as the first Director of the National Institute on Aging (NIA) from 1976 until 1982. Since that time I have held the positions of Brookdale Professor of Geriatrics and Adult Development, and Chairman of the Gerald and May Ellen Ritter Department of Geriatrics and Adult Development at Mount Sinai School of Medicine. Therefore, I know first hand about the programs, priorities, and accomplishments of the National Institute on Aging from its infancy in 1976 to its position today as the preeminent agency for the support and conduct of aging research and research training in the Nation, if not the world. vantage point in academia, I can testify to the value of an agency such as the NIA which has the power and strength, if we would only fuel it, to turn around what is potentially a devastating trend within our country.

rom my

During the period I was Director of the Institute, I was fond of saying that it was fortuitous that the NIA was established at a time when it could create programs directed toward acquiring new biomedical knowledge about the aging process so that the impact of the graying of the baby boomers (those born between 1945 and 1955) could be turned into a triumph rather than a tragedy. At that point in time, although the problems associated with our elderly citizens were serious, they were still at a level which was manageable by the individuals affected, their families, and society. If the Institute had not been created at that time and research into the myriad of health problems that often face individuals as they grow older had not been intitiated and expanded, it was inevitable that these problems would have, in a relatively short period, outstripped the capacity of our society to handle them.

In recent months, my optimism has turned to pessimism. The trend in the financing of aging research, if the President's budget for FY 1987 is enacted, is a "hold-the-line" position. It is inappropriate to hold the line at this particular juncture of the Institute's development. Its programs are just beginning to unravel the mysteries of the etiology, diagnosis, and treatment of Alzheimer's disease for example. Much, much more needs to be done in this important area if we are to progress toward the day when this debilitating illness is overcome. Research on the application of new molecular genetic techniques to

the study of the aging process could eventually provide the best chance for understanding, and therefore being able to change, the aging process. The study of the oldest old (those over 85 years of age), the fastest growing segment of the U.S. population, is important in that this group has a very high rate of morbidity and disability and therefore places a heavy burden on our health care system. More knowledge about this age group may assist in extending the healthy and effective functioning of individuals more into the later years and therefore reducing the burden on society and the health care system.

The understanding of the normal aging process which is being acquired through such studies as the Baltimore Longitudinal Study of Aging is important to provide knowledge about what normal aging is and is not, so that the process of aging can be separated from disease. These are but a few examples of the types of research that are being supported and conducted by the Aging Institute. It is pure folly not to continue to expand the research programs of the National Institute on Aging. Not to do so is wrong from the point of view of society; it is wrong from the point of view of research; it is wrong from the point of view of economics; and it is wrong in terms of the future of the country.

Biomedical research, among many things, must be considered an investiment in the future, and this is particularly true about research on aging. Studies have proven that for every dollar invested in research, society benefits as much as thirteen dollars - and this just in monetary terms. Nothing is included here to reflect the reduction in the pain and suffering of the victims and their families, both physical and mental. Based on the known growth of our population of older citizens over the next several decades, it would be extremely short-sighted and foolhardy not to make this investment in research on the costly health problems which, without intervention, will surely beset them. A ten percent reduction in the cost of caring for our clderly within the next ten years would save $10 billion annually. I am convinced that this goal is attainable! But, we need the foresight and courage to begin to make that investment now!!

Let me now describe several of the high priority activities of the NIA which present opportunities for progress in aging research and training.

At the time the Institute identified Alzheimer's disease as a high priority in 1976, there were only about ten grants throughout NIII supporting research in this area. This despite