There are 5,000 research scientists and engineers this year in SDI. The funding level requested by the administration will boost that in 1987 to 18,600 scientists and engineers in SDI.

The issue is that even with the higher dollars, you are going to find yourselves competing for the dollars because researchers follow the dollars, let's face it, and three out of four Federal dollars for research are going now into military research.

I am not saying that there is a transfer of science and knowledge, and all that, that comes out of even military research. But I am saying that we have to look more precisely at some of the infrastructures, as well as the dollars. It is not either/or, and that concerns me.

You have touched on that very well here in your testimony, about some of that support auxiliary personnel problem. These dollars are more than just budgetary dollars, they translate into people priorities. Does it sound familiar?

Dr. PARDES. I don't find any objection to your saying it a number of times. I would just like to get you as many cameras as possible so that you could say it to as many people as possible.

Senator HATFIELD. Just wait until we get television in the Senate, and then I will have a blue shirt on, and I will say it right on the floor of the Senate.

STATEMENT OF KENNETH SHINE, M.D., PRESIDENT-ELECT, AMERICAN HEART ASSOCIATION

Senator HATFIELD. Dr. Shine, we are happy to welcome you as well here today. Your full résumé and who's who will be placed in the record. I want to now turn to you to let you take advantage of the time that we are working under today to make your statement.

Dr. SHINE. I am Kenneth Shine, dean-designate of the UCLA School of Medicine. I would want to echo, in that capacity, Dr. Butler's comments this morning. We were among the real pioneers in geriatric education and training in the United States, and we are scrambling desperately to maintain those programs as Dr. Butler described.

I am also president-elect of the American Heart Association; it is wearing that hat particularly that I appear before you today.

We are very pleased that these hearings have been called because we believe that the public needs to become aware of this administration's budget proposals and their management policies as they impact upon biomedical research.

While the American Heart Association [AHA] continues to dedicate an increasing amount of its budgetary resources to plant seeds among young people to undertake careers in cardiovascular research, we are hopeful that the National Heart, Lung, and Blood Institute [NHLBI] will be able to continue to take advantage of current and future research opportunities in the field.

We are becoming increasingly concerned that decisions made by Federal officials for fiscal reasons in the present, may have detrimental long term impact on the ability of the institute to do so.

This morning, we were talking about fiscal implications. The economic cost of cardiovascular disease in this country is about $102 billion. Since 1964, over a 20-year period, there has been a 39-percent decrease in the mortality and morbidity in cardiovascular disease. Translate that into dollars, and we are talking about a cost that would have been $68 billion higher, that is somewhere in the range of $170 billion, and that is more than my lunch money, Mr. Chairman.

In addition to the Gramm-Rudman funding reductions that have already had a severe impact on NHLBI's programs, we are very concerned with management changes and additional funding reductions that appear on the horizon.

The President's 1987 budget proposals would require deep reductions in the programs of the Heart, Lung, and Blood Institute when research momentum, as already has been described, should not be slowed. The budget includes only $785 million, an overall reduction of 4.5 percent from fiscal year 1986, and below the adjusted appropriated level of $822 million.

The programmatic impact of the proposals on the Heart, Lung, and Blood Institute will be devastating. My written statement highlights the impact on each of the program mechanisms, but I would like to highlight one particular program area, namely, cholesterol research and education.

This is a prime example of where a voluntary health agency, such as the heart association, and the NHLBI work in a cooperative manner, both for prevention and treatment. It is noteworthy that the 1985 Nobel Prize went to Goldstein and Brown, who were supported by the heart association and the NHLBI, and whose research provides many of the clues which can be translated into decreasing death and disability from heart disease.

In the area of cholesterol research, over $4 million of grants in the NHLBI approved in 1986 will not be funded as a result of budget reduction. One important workshop on severe hypercholesterolemia has been canceled, another on the impact of dietary cholesterol and plasma lippoproteins is in jeopardy. There are a number of planned areas of investigation and education which will not be carried out because of a shortage of funds.

We have had to reduce the total number of publications with regard to cholesterol, and to reduce the number of spokespersons who can talk about the national cholesterol education project at conferences and meetings because of reduced travel.

The institute will have to reduce in scope some activities that are already underway, and it will have to decrease its activities in broadcast and print in carrying the program's message to the public.

The American Heart Association believes that the institute's efforts in cholesterol research and education should not be sidetracked or slowed at this time. We spent a substantial amount of money on the lipid research trials, they clearly demonstrated the efficacy of reducing cholesterol, and any reduction in funding which does not take advantage of this clearly does not allow a payoff on a previous investment.

The American Heart Association believes that the budgets for the national institutes are inadequate, and we will be appearing later this month to discuss this to a greater extent. At the same time, we would also like to highlight some of our concerns regarding the increasing involvement of the Office of Management and Budget [OMB] in the management activities of the institutes.

As we understand the situation, as of August 1985, the OMB instituted a new mechanism for apportioning funds to the institutes which, in turn, required the Office of the Director of the NIH to adjust its allotment procedure to the individual institutes. Prior to August 1985, OMB apportioned funds to the institute by total, and then the Director of the NIH allotted funds to the individual institutes with only two categories earmarked, SBIR and consulting services.

Allocation among programs of the remaining and largest parts of the institutes' budget were left to the individual institutes. Now the institutes receive their allotment from the NIH Director in 13 categories, each broken down by number of awards and dollar amounts as determined by the OMB.

We do not believe that the OMB has the scientific expertise and outlook to be making these kinds of decisions. These decisions should be made by the individual institutes and their advisory councils, with input from the biomedical research community. Even though institute directors have some reprogramming authority, it is our understanding that use of this authority has been discouraged under this new system.

The heart association believes that the programs of the NHLBI have been highly successful in the battle against cardiovascular disease because of the valuable principles which guide the institute, maintaining program balance. The OMB's new allocation and apportionment procedures are threatening the success of this time honored approach.

The Heart, Lung, and Blood Institute is by nature a clinical institute. In order to maintain balance that addresses needs, as well as clinical aspects of heart, lung, and blood diseases, the institute and its advisory council must be given a proper amount of flexibility to allocate resources where they are most needed, and where they will bring the best results.

I will echo the discussion this morning with regard to the lack of support for certain of the centers. In response to Senator Weicker's question and comments, I would point out that at the Heart, Lung, and Blood Institute, the percentage of individual grants has appropriately risen, but it is now at the level of 70.4 percent, with only 11.7 percent in centers, and 7 percent in other forms of funding, which we believe to be important.

Finally, as an educator, I must emphasize again the particularly deleterious effect of these developments upon the recruitment of outstanding young people, particularly physicians, for careers in research.

Until recently, Congress had moved effectively to stabilize the NIH funding situation, but the implications of Gramm-Rudman for research are not lost upon the best and brightest of our young people. They see

uncertainty, instability, and an erosion of this Nation's commitment to biomedical research.

More than anything else, the scientific community, and particularly potential young scientists need some sense of vision. They need to know where biomedical research is going. They need to know whether they can stake their professional careers upon it.

Dr. Thier, this morning, made reference to the importance of biomedical research support grants [BRSG] to universities. This is a key issue because the $5,000, $6,000, or $7,000 in appropriations to young investigators as part of the BRSG is crucial.

Gramm-Rudman stands as the sword of Damocles over the heads of biomedical research and biomedical researchers. We believe we must have a better vision for our future.

Senator Weicker raised questions this morning about what the role of our scientific community should be in terms of the education of the public with regard to funding cuts. The Board of Directors of the American Heart Association have passed resolutions expressing their deep concern about overall funding, as well as the increasing OMB management of research. Those positions have been endorsed by some 55 affiliates of the American Heart Association throughout the country. There is a growing sense among the volunteers of the American Heart Association that we must take greater action and bring to the public our great concerns with regard to what is happening to our biomedical research endeavor.

PREPARED STATEMENT

I thank you for the opportunity to appear and to discuss these issues with the committee.

[The statement follows:]

STATEMENT OF DR. KENNETH SHINE

I am Dr. Kenneth Shine, Dean-Designate of the UCLA School of Medicine, and President-elect of the American Heart Association (AHA). The AHA is the only voluntary agency in the United States devoting all of its human and financial resources to one goal: the reduction of premature death and disability caused by heart attacks, stroke and other blood vessel diseases. In accomplishing this goal, we work in partnership with several Federal research, education and prevention programs whose goals are similar in nature. Since 1948, the AHA and the National Heart, Lung and Blood Institute (NHLBI) have been active partners in the battle against cardiovascular disease this Nation's leading cause of death. We are very pleased that you have called these hearings. We believe, as you do, that the public should be aware of the impact of the Administration's budget proposals and other management policies on the progress of biomedical research in this country.

Cardiovascular disease is responsible for almost one million deaths each year. Heart disease, stroke and related disorders account for almost as many deaths as all other causes of death (cancer, accidents, etc.) combined. In 1986, the total economic costs associated with cardiovascular disease are estimated to be over $102 billion in direct medical expenses and lost output due to disability and death. However, there is encouraging evidence that we are making progress against these diseases. Between 1964 and 1984 the death rate for all cardiovascular disease declined by 39 percent. The decline in the death rate for coronary heart disease was 40 percent and for stroke, 55 percent. These encouraging downward trends contributed to 76 percent of the decline in overall mortality between 1964 and 1984 in the U.S.

Throughout our 37-year partnership the research, training, education and community service programs of both the AHA and the NHLBI have had a significant impact on diseases of the heart and circulatory system. While AHA continues to dedicate an increasing amount of its budgetary resources to cardiovascular research, we are hopeful that the NHLBI will be able to continue to take advantage of current and future research opportunities in the cardiovascular field. We are becoming increasingly concerned that decisions made by Federal officials for fiscal reasons in the present may have a detrimental long-term impact on the ability of the Institute to do so.

In addition to the Gramm-Rudman funding reductions that have already had a severe impact

on NHLBI's programs, we are very concerned with management changes and additional funding reductions that appear on the horizon. Although we have made great progress in the fight