This proposal does not seek to play a "numbers game" and establish another arbitrary formula in place of that proposed by the President. Rather, this proposal is based on the present scientific excitement in the field and the importance of the research that can be done. It is derived from the scientific opportunities and recommendations of the IOM report. Specifically, it would: What lesson is the Administration with its budget proposals teaching to those suffering from mental or substance abuse disorders? What lesson is taught those young physicians and others considering a career in research into these illnesses? For the former, it is a reaffirmation of the stigma attached to mental illness or addictive disorders. For the latter, it is a confirmation that the Nation's research commitment does not lie in this field, and that entering it is folly. A vicious cycle of diminished financial resources leading to diminished interest and involvement in research is created, resulting in tremendous potential loss to society as a whole. If the Nation fails to invest wisely in efforts to reduce the costs of mental illness and addictive disorders, we all will continue to pay the price in increased hospital care, increased secondary illness, lost productivity and, ultimately, lost lives. We are confident, Mr. Chairman, that enhanced funding can yield dividends in advancing scientific knowledge, and we stand ready to work with you in this endeavor. Senator HATFIELD [presiding]. Thank you very much, Dr. Pardes. Senator HATFIELD. Yes; just one moment. Dr. Pardes, I want to especially welcome you to the subcommittee today, and to thank you for your very eloquent testimony. You have always been most articulate on behalf of your area of medicine and research. You have made a comment about the President's budget. I think that it is pretty clear by now that the President's budget was DBA, dead before arrival, and not on arrival, and that was affirmed by, first of all, this subcommittee under the chairmanship of Senator Weicker, from the first hearing that we held, that we were not going to measure our product, or what we wanted to end up with as our product, by the President's budget. Then, the Budget Committee itself put it to a test, and got only, I think, five votes for it. So I think that it is pretty clear that the Congress is not moving in that direction. I wish I could be definitive at this time to you, except to say that I know that under the leadership of the Appropriations Committee, in general, the subcommittee in particular, there is a very strong commitment to medical research which far exceeds that which are the levels indicated by the President's budget. The Senator from Pennsylvania. Senator SPECTER. Thank you, Mr. Chairman. I just wanted to say a word or two of introduction about Dr. Durant, who is the next witness. Dr. Durant is the president of the American Society of Clinical Oncology, and president of the Fox Chase Cancer Center in Philadelphia, a very distinguished clinician and physician. I wanted to make those very brief words of introduction for him. As usual, we introduce those who do not need introductions, but as a longstanding friend, I wanted to be here to say that. I have reviewed his statement, and it is an excellent one. I regret that other commitments prevent my staying. I would associate myself with your remarks, Mr. Chairman, about my own commitment to medical research, evidenced by my votes in support. I think that this subcommittee will lead the way in providing the kind of assistance necessary and appropriate for the very important research work in this country in the medical field. Thank you, Mr. Chairman. Senator HATFIELD. Thank you, Senator Specter, for your comments and the introduction of Dr. Durant. We are happy now to hear from you, Dr. Durant. Welcome to the subcommittee. STATEMENT OF JOHN R. DURANT, M.D., PRESIDENT, THE FOX CHASE CANCER CENTER Dr. DURANT. Thank you very much, Senator Hatfield. I would like to reiterate a theme that you have heard this morning again and again, and that is that the opportunities were never greater. Fifteen percent of the people who work in my basic research operation are members of the National Academy of Sciences, so they are not trivial in their achievements, and there was never more excitement in our laboratories about the potential for doing something important about the problem of cancer. In addition, what Senator Specter didn't tell you is that it is very important to me personally. My wife happens to have the disease. My sister has the disease. My mother and father-in-law also both have the disease. So I have a personal investment, which many Americans have, in seeing something important done about this problem. If you were running a business and you had the opportunity to make $13 on every $1 you put into the business, I think that you would probably take it. That is what we think the fiscal opportunities are in fundamental biomedical research in this country. I think that it is pennywise and pound-foolish to follow the principles of the President's budget. There are a number of consequences that I would like to stress about some of the things that are happening. First of all, if this comes to be, at least at the National Cancer Institute, the percentage of grants to be funded would fall to about 27 percent, well below what is believed to be the optimal level of funding for new and competing research grants, a very important fundamental basis for our research effort. Second, I am very concerned about the facilities in our country. Sam Thier testified in the last session about the report to Dr. Keyworth that was delivered last year at the request of the President concerning the state of facilities and indirect costs in our country. The need for operating budgets, I think, is measured in the tens of millions of dollars and the need for improving and renovating our facilities may be in the hundreds of millions of dollars. Recently, Dr. Armand Hammer and the American Cancer Society funded a study of just what would be needed for cancer research and for all the research establishment, and they found that universities and research institutes, such as the one I represent, were going to raise new funds of their own of about 56 percent, but they needed 44 percent from the Federal Government, and that represented $350 million just for cancer research facilities over the next 4 years. In addition, the Keyworth report suggested that indirect cost reimbursement related to amortization of buildings and equipment were unduly unrealistic. Buildings are amortized over 50 years at present, and they recommended 20. Equipment is amortized over 15 years, and they recommended 5 to 10. This would drive up indirect costs, not down as is currently being recommended. Another important area that has been mentioned before is centers. We are currently operating at my center, before Gramm-Rudman, at 88 percent of recommended levels, that is a similar budget reduction to most of the cancer centers in the United States. Congress has previously suggested that these should be funded at 100 percent. If the budget cuts occur, of course, they may be reduced still further. Once again, I would like to say, I think the opportunities were never greater, but we are about, if something is not done, to waste these opportunities in what I consider to be foolish budget reductions. PREPARED STATEMENT I thank you for the opportunity to speak to this issue. [The statement follows:] STATEMENT OF JOHN R. DURANT I am John R. Durant, M.D. I am president of the Fox Chase Cancer Center located in northeast Philadelphia. We are, with the University of Pennsylvania, 1 of the 20 comprehensive cancer centers designated by the National Cancer Institute. We have an annual budget of about $47 million and expend $18 million annually on cancer research. Of this $18 million, about $14 million is provided by peer reviewed applications, most from the National Institutes of Health. I am also president of the American Society of Clinical Oncology, an association of more than 6,000 clinicians who care for most of the Nation's cancer patients and which represents most of the academic clinical oncologists in the United States. I have recently been appointed by President Reagan to the National Cancer Advisory Board, the 18 person policy advisory group which serves the Director of the National Cancer Institute. I am past president of the American Radium Society, the oldest clinical cancer research organization in the country, and of the Association of American Cancer Institutes which represents most of the academic cancer centers in the United States. Finally, I am treasurer of the National Coalition for Cancer Research which represents most of the professionals in the United States who do cancer research. Therefore, I feel particularly qualified to discuss the problem of funding for cancer research. Senator, you are familiar with the highly publicized effort, which you supported, to fund 6,100 new research grants this year. I support this effort; however, its effectivensss is being seriously eroded by the Gramm-Rudman-Hollings Act which, if permitted to persist, will eventually remove $13 of benefit to the economy for each $1 of savings to the budget. This is severe enough by itself, but is trivial compared to the long-term effects of the relatively stable budget in dollars which has occurred for the National Cancer Institute over the past decade. No real increases in dollars and, therefore, real decreases of significant amounts have affected the budget for centers, training, construction, the intramural programs, and clinical trials. Centers are now operating at 88 percent of recommended levels. Training of new academicians is more essential than ever. Clinical trials, the mechanism by which bench research is translated to public benefit, are suffering badly. Because of severe cutbacks in funds, the National Cancer Institute is going to have to eliminate seven groups this year, a severe dismantling of the system. The problems of the intramural program are well known. The most important problems, however, are construction, renovation, and equipment. Two recent studies demonstrate the dimensions of the problem. The ACS-Armand Hammer study indicated that just for cancer research, the academic centers of this country would need $1.5 billion to modernize their facilities by 1990. They anticipated that they could raise 56 percent of this from their own sources, but 44 percent ($360 million) would have to come from Federal sources. The Keyworth report to the President, delivered in December 1985, stated that current assumptions regarding depreciation in the indirect cost reimbursement formula were unduly stringent. It was recommended that amortization for buildings be over 20, not the current 50 years, and that for equipment be 5-10 years instead of the present 15. These two reports come at a time when $1 million is all there is in the budget for the National Cancer Institute for new construction and when the Office of Management and Budget wants to reduce indirect costs, not increase them as President Reagan's last science advisor recommended. Senator, I live in the Northeast where the general infrastructure has been allowed to deteriorate through deferred maintenance. Our roads are a series of pot holes traversing cities whose sewage and water systems leak and which contain hundreds and thousands of acres of abandoned buildings. We must not allow our biomedical scientific infrastructure to suffer the same fate. The budget for this purpose is the people's defense budget against disease. They are more afraid of cancer than any other disease. The infrastructure which supports the research to defend against this disease is under pennywise and pound-foolish attack. I urge you, therefore to: One, oppose changes designed to reduce indirect cost reimbursement. Two, support generous funding for the National Institutes of Health and the National Cancer Institute this year's appropriated budget of $1.2 plus billion for the National Cancer Institute would be a good start. Three, support funding, as the Congress has done in the past, at 100 percent of recommended levels for centers. Four, maintain research training. Five, restore cuts in the intramural budget. Senator, our Nation's defense budget against disease is every bit as important as its budget against nuclear and conventional war. We cannot negotiate either from weakness. Neither can we expect research to be done when insufficient numbers of new scientists are being trained to work in increasingly outmoded facilities equipped with aging and outdated equipment. I urge the prompt attention of the Congress to these urgent and important matters. Senator HATFIELD. Thank you, Dr. Durant. You know, Dr. Durant, you touch on a very deep concern of mine, which is to look beyond the dollars involved and whether we are funding at so many dollars or other dollar levels, whatever, because when we are aware that over 60 percent of the teachers in secondary education today in America are temporarily certified in order to provide some kind of a teacher role in those classrooms-temporarily certified because they are not truly qualified to teach those subjects from an academic background or experience or education-it really tells us what is happening to the foundation, which ultimately will be manifest in all fields of research in the scientific medical field, because if we are not getting those secondary programs bolstered in quality to stimulate, to bring students' interest to a peak, to follow through into the higher educational experience, we are really losing the very basis of the whole enterprise of research. That concerns me. Another thing that concerns me is that no matter how many dollars we may fund at this particular program in medical research, look at the growing competition for that limited personnel, scientists-Herb has heard me talk about this frequently, and he is probably saying, here I go again. I just feel that it has to be repeated every chance I have. |