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STATEMENT OF DR. PATRICIA SWAN

My name is Dr. Patricia Swan. I am vice Provost for Research and Advanced
Studies and Dean of the Graduate College at Iowa State University.

I thank the committee for the opportunity to address the needs of the nutrition research community. I am here on behalf of the American Institute of Nutrition (AIN).

AIN consists of about 2,700 biomedical researchers from nearly every majoc research, education, and clinical institution in the United States. I am here to address some of the concerns we have related to mutritional research, specifically, the need for a nutrition specific agency or division in the National Institutes of Health (NIH). I also wish to talk about the state of federal funding for basic and clinical nutrition research, research training in mutrition and the need for more NIH Clinical Nutrition Research Units.

Many of the problems facing nutritional research today stem from the lack of a federal entity to oversee nutrition research on a national scale.

Federal funding committed to nutritional research is spread among several agencies including the Department of Health and Human Services and the Department of Agriculture. In many cases, basic nutrition research funding is obscured because it is categorized with other types of funding. The National Institute of Diabetes, Digestive, and Kidney Diseases (NIDOK) is generally regarded as the major NTH institute supporting mutrition research, yet it only controls about 20 to 25 percent of the funding devoted to mutritional research at NIH. The rest is scattered among other NIH institutes. Nutritional research is consequently lost among the other interests of NIH. Although there are institutional attempts to coordinate, there is no pro-active leadership for nutrition research as it might assist in major public health efforts such as implementing the Dietary Guidelines for Americans. In fact, many believe it ironic that NIH does not have a healthrelated National Institute of Nutrition.

Recent efforts to integrate nutrition activities among the various agencies have been only partially successful. Though assurances have been given by the Director of NIDDK and the Director of the Division of Digestive Diseases and Nutrition that nutrition research is receiving adequate attention, we believe that at least a division level agency for leadership in mutrition is needed at NIH.

Language requesting NIH to examine the feasibility of such a division was included in this committee's report to Congress last year. As you may recall, the committee "strongly reconmended that NIH review the feasibility of elevating nutritional science to divisional status in one of the National Institutes of Health."

Stronger Congressional support is needed to establish a federal agency solely concerned with the science of nutrition and its practical, medical, and public health significance and contributions. It's important that your subcommittee continue to insist that the agency respond.

We know that good nutrition can reduce the threat of diabetes, hypertension, heart disease, cancer, and the largest nutritional disorder in the United States, obesity.

To better understand how mutrition assists in the prevention of these diseases and promotes health, we must first understand the mechanisms of nutrient actions. When that is clearer, we will then have a better idea of how to determine individual needs to sustain optimal activity of many metabolic systems. Training of future generations of professionals is equally crucial to the further role that nutrition can play in health maintenance and disease prevention.

This clearly requires more research at the molecular and cellular levels as well as combined and vigorous efforts at the more anplex organ, whole body and population levels of study to build on the base of nutritional information.

Congressional support has been given for nutritional research funding, but this only amounts to four percent of the NIH buget and more is needed. In contrast, food and agriculture contribute more than one-fifth of the U.S. Gross National Product. I again refer to this aanmittee's report to the last Congress that recognized the central role of nutrition in disease prevention and the relative lack of funding for nutritional research. The report stated that "it is notable that so little has been done to build the scientific base of nutritional information that might lead to better methods for anplying with recommendations and a better understanding of how to prevent and treat mutritional disorders."

There is difficulty in accurately assessing the size of the research enterprise in nutrition because it is a bridging discipline that auts across so many different folds of biamedical science. However, this emphasizes the pervasive nature of nutrition in biology and medicine and underscores the need for integration of nutrition research within a specific unit at NI}.

I ask this committee to again address in its report the need for a mitrition division at NIH. We would like this subommittee to assure its language requesting a division for nutrition at NI}l be retained in the Labor/IALS conference report.

Finally, I would like to urge more support for clinical nutrition research facilities. To date, only seven Clinical Mutrition Research Units (ANRUS) have been established. The ONRUS conduct mission-oriented research that help implement nutrition research on a human scale.

You don't have to look far to see that we live in a health-conscious society. The billions of dollars spent every year on fad diets or the contimal bombardment of commercials pushing the latest healthiest food provide plenty of evidence that Americans are concerned about what they eat. Surprisingly, and regrettably, the NIH hasn't responded with the support for mutrition research that the public interest deserves.

Basic mutrition research probably doesn't generate much constituent mail for the members of this subcommittee. But rest assured, your help in providing the funding for nutrition research through NIH will help all the people you represent. Mutrition research greatly benefits every person in this country simultaneously.

I thank you for allowing me to testify at this hearing.

NUTRITION Senator ADAMS. Doctor, we will try to once again press as we did last year for a separate portion of NIH for nutrition. I might state to you that I will be holding hearings in an entirely separate committee on Friday, the Subcommittee on Aging of this full committee, dealing mainly with women's health problems, menopause, and osteoporosis, which we believe are directly connected with nutrition. So we will try from that direction also to move Dr. Healy and some of those at NIH to deal more with nutrition problems.

Many of us are recognizing and I think the public is recognizing-I hope it does not just become a fad—that nutrition is a basic part of preventive health, and if we can improve our nutrition, particularly for our citizens that are growing a little older and for our children, we will avoid many health problems.

I thank you for your testimony. It was excellent. We appreciate your being here.

Dr. Swan. Thank you very much. STATEMENT OF DR. ELLIOT VESELL, CHAIRMAN, PUBLIC AFFAIRS

COMMITTEE, AMERICAN SOCIETY FOR PHARMACOLOGY AND

THERAPEUTICS Senator ADAMS. Our next testimony is from Dr. Elliot Vesell, chairman, public affairs committee, the American Society for Pharmacology and Experimental Therapeutics.

Welcome, Doctor. We welcome you to the committee this morning.

Dr. VESELL. Thank you very much, Senator Adams. I appreciate this opportunity to testify before your subcommittee.

Pharmacology is the science that deals with the actions of drugs and the discovery of new drugs. The Pharmacology Society has a membership of 4,300 scientists involved in basic and clinical research, administration, and teaching throughout the United States. Every year your subcommittee hears testimony from various groups representing hundreds of thousands of Americans who suffer from medical conditions for which there are no currently known cures. The only hope for most of these people is basic biomedical research, the vast majority of which is funded through the National Institutes of Health and ADAMHA.

In fiscal year 1991, Congress appropriated $5.18 billion for research project grants at NIH and ADAMHA. As generous as this was, it still represents less than seven-eights of 1 percent of the total expenditure for health care. Less than 1 percent expenditure for R&D is, as Dr. Edgington pointed out, less than other industrialized countries provide. If we are ever to reduce health care costs which are astronomically high and health care needs, the answer lies with increasing basic biomedical research and specifically with increasing the financial resources devoted to investigator-initiated research project grants. This is a theme you have heard throughout the day.

Two recent studies by highly respected Battelle Institute Medical Technology Assessment and Policy Research Center demonstrate convincingly the correctness of this approach and the past savings achieved through biomedical research. They offer a glimpse of the future benefits we can expect from today's investments. The first study evaluated the human and financial benefits of some of the most important biomedical successes of the past decades. In analyzing polio, tuberculosis, coronary heart disease, and cerebral vascular disease, the study found that the products of pharmacological research alone affected the lives of more than 1.6 million people and saved close to $141 billion. In other words, it was cost effective.

For example, the study estimates that because of research success, America has avoided nearly 1 million cases of polio, 400,000 of which would have resulted in severe disabilities. Costs associated with these cases would have totaled as much as $31 billion.

Funds provided to NIH and ADAMHA thus have resulted in major costs savings to the country and have saved or improved the quality of life for millions of your constituents. These investments were in basic research.

The second study makes it clear that biomedical research is at the threshold of major discoveries that will revolutionize clinical practice and affect the lives of millions of Americans and save hun

dreds of billions of dollars. The study makes it clear that the taxpayers' investment in biomedical research will continue to be a wise one. This study from Battelle estimated the number of cases and deaths that will occur in the next 10 to 25 years from five diseases alone cardiovascular, cancer, arthritis, Alzheimer's, and AIDS taking into account demographic changes.

The study then used expert forecasting to project the impact that lifestyle changes and medical advances will have on rates of death and disease, and then it estimates the resulting economic benefit. Again, the saving was great, and I have it in the testimony so I will not go into the details here.

Over and over again it has been demonstrated that investment in basic research has major savings. With the epidemics that now exist in this country, we need to launch, I think, an Operation Health Shield. This is imperative to our own future, and it is a direct way of reducing the astronomically rising health costs.

PREPARED STATEMENT

Just think of what we would have had to put into iron lungs for polio if we were still at that stage. It would be billions and billions of expenses on new and better iron lungs. But instead, we went to basic research and solved the problem. We can do the same for AIDS, and I beg you and your committee to consider this a national emergency and to help us do the right thing. Thank

you. [The statement follows:)

STATEMENT OF DR. ELLIOT S. VESELL

Mr. Chairman and Members of the Subcommittee:

Thank you for providing us an opportunity to testify before your Subcommittee. I am Dr. Elliot S. Vesell, Evan Pugh Professor and Chairman of the Department of Pharmacology at the Pennsylvania State University College of Medicine at the Hershey Medical Center. I am also Chairman of the Public Affairs Committee of the American Society for Pharmacology and Experimental Therapeutics (ASPET). I am accompanied by Mr. Anthony Mazzaschi, Public Affairs and Education Officer for the Society.

Pharmacology is the science of the actions of drugs and the discovery of new drugs. ASPET has a membership of more than 4,300 scientists involved in administration, basic and clinical research, and teaching throughout the United States. Pharmacologists are found in schools of medicine, nursing, and pharmacy, in private and government research laboratories, and in a wide variety of pharmaceutical and biotechnology industries. Their teaching efforts are a vital part of the formal education for the health care practitioners of tomorrow; their research efforts are crucial to the development of new medicines to fight diseases and to improve human health

According to the Health Care Financing Administration and the U.S. Department of Commerce, more than $756 billion will be spent in fiscal 1991 on health care in the United States, up over 53 percent in the past five years. Many of these health care expenditures are paid by the federal treasury through Medicare, Medicaid, and federal employee health insurance outlays. The federal deficit has clearly been exacerbated by health care costs that often appear to be out-of-control.

In analyzing the balance sheets, it is easy to forget that these health care costs are going to treat real men, women and children - our relatives, neighbors, and your constituents. Every year, the Subcommittee hears testimony from various groups representing hundreds of thousands of Americans who suffer from medical conditions for which there are currently no cures. The only hope for most of these people is basic biomedical research, the vast majority of which is funded through the National Institutes of Health (NIH) and the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA).

In fiscal 1991, Congress appropriated $5.18 billion for research project grants at NIH and ADAMHA. As generous as this was, it still represents less than seven-tenths of one percent of the total expenditure for health care. If we are ever to reduce heath care costs and health care needs, the answer lies with increasing basic biomedical research and specifically with increasing the financial resources devoted to investigator-initiated research project grants. Two recent studies by the highlyrespected Battelle Institute's Medical Technology Assessment and Policy Research Center validate the past savings achieved through biomedical research and offer a glimpse of the future benefits we can expect from today's investments..

The first study evaluated the human and financial benefits of some of the most important biomedical successes of the past decades. In analyzing polio, tuberculosis, coronary heart disease and cerebrovascular disease, the study found that the products of pharmacological research alone affected the lives of more than 1.6 million people and saved close to $141 billion. For example, the study estimates that because of research success, America has avoided nearly one million cases of polio, 400,000 of which would have resulted in severe disabilities. Costs associated with these cases would have totaled as much as $31 billion dollars. Make no mistake, the funds provided to NIH and ADAMKA have resulted in major cost savings to the country have save or improved the quality of life for millions of your constituents.

The second study makes it clear that biomedical research is at the threshold of major discoveries that will revolutionize clinical practice, affect the lives of millions of Americans and save hundreds of billions of dollars. The study makes it clear that the taxpayers investment in biomedical research will continue to be a wise one.

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