Recently, both the AHA Board of Directors and the NHLBI Advisory Council passed resolutions expressing their concerns regarding the new role of the Office of Management and Budget (OMB) in determining and proscribing line items in the budget of the National Institutes of Health (NIH) and individual institutes. Copies of these resolutions are attached to this statement. The AHA believes that micromanagement by a nonscientific agency such as the OMB adversely preempts the traditional flexibility of the NHLBI, its Advisory Council and the scientific community from participating in the setting of priorities for biomedical research.

As an educator I must emphasize the particularly deleterious effects of these developments upon the recruitment of outstanding young people for careers in research. Until recently Congress had moved effectively to improve the stability of the NIH funding situation. The implications of Gramm-Rudman for biomedical research are not lost upon the best and the brightest of our young people. They see uncertainty, instability and further 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. Where is our biomedical research establishment going? When we ask young people to determine their professional careers, what is their future? Gramm-Rudman stands as a sword of Damocles over the heads of biomedical research and biomedical researchers. We must have a

better vision for the future.

Again, I want to thank you for the opportunity to raise these issues and I would be happy

to answer any questions you may have.

Senator HATFIELD. Thank you, Dr. Shine.

On page 1, where you refer to the statistics between 1964 and 1984, the death rate of all cardiovascular disease declined by 39 percent. Then I believe you used a figure of $68 billion. Is that what you would call a savings because of the decline?

Dr. SHINE. The best figure we have at the present time is our contemporary cost, which is about $102 billion. If you assume that there had not been that kind of decline, then that cost, instead of being $102 billion, would be $170 billion.

Senator HATFIELD. In other words, that is an equivalent to that kind of a savings because of that decline, directly related to that decline.

Dr. SHINE. That is right. It is much as Dr. Thier was talking about this morning. If you do things well, you don't see or hear about it because it disappears. Those are costs that have disappeared because of those decreases in morbidity and mortality.

Senator HATFIELD. I always like to have both the humanitarian statistic as well as the economic statistic. Sometimes, some minds that we have to try to communicate with only respond to the dollar and economics of it, and others respond to the pain and suffering, the quality of life approach. It is very helpful to have both.

Let me just comment further on the matter of education of the public.

We constantly are finding ourselves in a battle position where we are recommending out of this subcommittee, and the full committee, a certain figure for certain categories of programs, in this case for medical research. We will ultimately evolve a proposal, and this proposal will then probably be challenged by the administration, if I can predict the events down the road correctly, and/or certain elements within the Congress who represent the perspective of the administration that we have to reduce these programs in order to make more money available for other programs.

At that point in time, we will have a specific rallying point. These resolutions that have been passed in general about the President's budget are helpful, but really the need will be to mobilize public opinion at that point in time, when we are ready to move to the floor and engage in the battle.

I am hopeful that our relationships and communications, particularly, will be such that we can then give you the bugle call, and call you to arms to mobilize these very people out to their own Senators and their own Representatives, because that will be the real call for public opinion to come to play.

Dr. SHINE. I would agree, Senator. At the same time, our feeling has been that the educational process has to begin as early as possible, so that when the bugle call comes, people understand what the issues are, and can respond in an appropriate way.

It is an interesting dilemma for the voluntary health agencies because, obviously, our principal concern is in reducing death and disability by research and public education, but I think that it is becoming increas

ingly clear that the voluntary health agencies must take positions with regard to the funding of that since that is such a critical element of whether we will be sucesssful or not.

Senator HATFIELD. That is right. But you see, we have to move from the general of mobilizing indignation, or outrage, or all of those other things, down to the very specific point of the battlefield. Sometimes there is a slippage between those two efforts because, in part, the public has to have something very specific in instruction of how to make its voice heard. They have to be able to refer to a bill, to a measure, to a particular vote that is coming up, and that has to be not only to inform them of that, but then the name of the precise individual with whom they can communicate, particularly from their own States. Then, to extrapolate further, they need the names of the candidates running for reelection this year, because that is when they are most responsive_ when we are most responsive.

If you will excuse me, doctor, I will run and vote, and then come back. I want to hear your testimony, if you will be patient with us. [A brief recess was taken.]

STATEMENT OF DR. GEORGE PALADE, WINNER OF THE NOBEL PRIZE FOR MEDICINE, AND PRESIDENTIAL MEDAL FOR SCIENCE

Senator HATFIELD. Dr. Palade, we are ready now to receive your testimony, and your impressive résumé with all of the recognition, national and international, will be placed in the record.

Dr. PALADE. Thank you, Senator. Let me start by thanking you for giving me this opportunity to testify before you and your subcommittee on the question at hand, which is the question of the Presidential budget.

Senator HATFIELD. Would you pull that a little closer to you, Dr. Palade, the acoustics in this room are very, very poor. We did not have a good engineer for this, I am afraid, they are all out at the Pentagon. [General laughter.]

Dr. PALADE. While I have been active, and I am still active in basic biomedical research, I am going to talk from this vantage point. In addition to this, my relations with the National Institutes of Health have been primarily with the National Institute of General Medical Science. Again, it is from this point of view that I am addressing the issue and the discussion.

It was already mentioned, but it definitely deserves to be stressed, that we are in a unique situation in the history of biomedical sciences and biomedical research. At no other time in the history of this scientist have the opportunities been so great, so promising, so clearly open in so many directions, and in such a depth.

In contrast to the opportunity curve, which promises to go upwards for at least two or three decades, if not more, we are looking at the other curve, which is the curve of the support given by the Federal Government to basic research. This curve is going down year by year, and when it comes to the Presidential budget for 1987, the drop is alarming. This is what we are trying to address.

Now, you realize that between these two curves, there is a big angle and a large area. That angle is the index of our lost opportunities, and it is at the same time the index of the opportunities that will be used by our competitors, friendly or unfriendly, which can capitalize on what we have realized already, but we cannot push through because of lack of proper support.

Now, no logically organized, rationally organized, or efficiently run business would behave in this way. In other words, the disregard of opportunities for the sake of the emergencies of the moment does not make sense.

The scientific community is clearly aware of the situation, but we should realize that it is not only at this level that the situation is rather well understood. It is also at the level of the administrators of science. The strongest voice in support of a change in the policy of the Government comes from Erich Bloch, the Director of the National Science Foundation, who is advocating an increase by 50 percent of the funds directed by the Government in support of basic research across the board.

It is not only the Director of the National Science Foundation who recognizes properly the situation, but it is also the Scientific Advisory Board of the President, which came with exactly the same figure, 50 percent increase in funds allocated to basic research.

Now what is the situation as far as biomedical research is concerned? We are not looking at any kind of increase, and definitely not an increase of that order. We are looking at a steady decrease.

Let me look at a few figures to indicate where we stand. I am part of a delegation for basic research, and with that delegation, I came a number of times in the past to participate in hearings in Congress, the Senate, and the House of Representatives.

That delegation decided, 1 year or so ago, that a long-range plan is needed for the support of basic biomedical research in this country. It came up with the idea that, as a reasonable compromise between budgetary restrictions and the need of growth justified by the opportunities I was mentioning, we should have a program that will arrive at the steady state of about 10,000 new research grants per annum.

At the present the situation is as follows: Last year, NIH supported about 6,000 grants, the figure is still hazy. The Presidential budget for 1987 will allow the support of 5,100 grants of this category, which is new and competing grants. Please notice that the 10,000 figure advocated by the delegation for basic research comes very close to the 50percent increase in support of basic research, including biomedical research, from the National Science Foundation and the Scientific Advisory Committee of the President.

In addition to the fact that money earmarked for grant support, individual grant support, training is also affected by the reductions. Last year, we had 10,000 people under training in different categories, and we don't have to go through the details. The 1987 budget provides for 9,100 new trainees, which is a very substantial reduction.

The NIH budget in 1986 was $5,660,000. The Director of NIH recommended, for 1987, a budget of $6,400,000,000. The Presidential budget for 1987 is $4,930,000,000. So we are clearly going down in funding, numbers of research projects, and the number of trainees. But we are going down in many other indices.

This is the percentage of the national gross income or product that is earmarked for research, including biomedical research, which is going down in this country and is going upward in other countries—the percentage of money allocated to research by comparison with the total health budget of the Nation. Senator Weicker mentioned that $2,000 is spent per person per annum for medical care, and only $25 per person per annum is spent in research.

What we have to realize is the fact that the research programs which were supported primarily by NIH and by NSF have produced the present situation in which the opportunities in all directions are impressive, if you like, amazing, not only in prenatal diagnosis of congenital diseases, but also in cardiovascular disease, also in neoplastic diseases, and also, to some extent, in mental diseases.

If we go now to basic research, we were never closer to understanding basic phenomena, important phenomena, like how cells control the differentiation, or how an egg finally develops in an organism that can become, in time, either a scientist or a Senator.

We are on the threshold of making extremely important advances in biomedical findings, yet what we should realize is that the money invested there has had an influence far beyond the field of biomedicine. It has affected, to a very large extent, animal agriculture, and plant agriculture, not to speak of the pharmaceutical industry. It is affecting now the industry at large to the extent that $40 billion per annum is generated in this country as a result of nonmedical applications of research done either at NIH or NSF biomedical programs.

This is where we really stand. So when the Director of NIH comes and pleads-he is not supposed to plead, excuse me. When he says that in his professional judgment, the budget for NIH for this year should be $6.4 billion, this is a minimal estimate, definitely a minimal estimate, and should be considered as such.

Our delegation has studied in detail the budget, and believes that NIH, in order to be able to carry through its mission, needs a very clear budget of $6.7 billion in 1987. I know you can see the difference in what we believe is reasonable, but it is not at the 50-percent increase advocated by Erich Bloch, or by the Scientific Advisory Board to the President, and what the administration recommends.

There is another problem, which is quite important. The President, in his address when he gave the National Medal of Science, indicated a deep sympathy and interest of the administration in basic research, and he indicated that this year his budget provides a 24-percent increase in basic research. This 24-percent increase in basic research, this indicates very clearly what is the disproportion between basic research applied to defense problems, and basic research applied to civil needs, including