107th Congress

Report: Fundamental Research-Biomedical Research in the Future—Hearing Before the House Committee on Appropriations Subcommittee on Labor, HHS, and Education—March 19, 2002

Members Present

Ralph Regula (R-OH), Chairman; David Obey (D-WI), Ranking Member; Steny Hoyer (D-MD); Patrick Kennedy (D-RI); and Don Sherwood (R-PA).

Witnesses:

Ruth Kirchstein, Acting Director of the National Institutes of Health (NIH); Marvin Cassman, National Institute of General Medical Sciences (NIGMS); James Battey, National Institute on Deafness and Other Communication Disorders (NIDCD); Richard Nakamura, National Institute of Mental Health (NIMH); Glen Hanson, National Institute on Drug Abuse (NIDA); Judith Vaitukaitis (NCRR); and Ellie Ehrenfeld (CSR).

Also in attendance were Susan Quantius, Associate Director for Budget, and Kerry Weems, Acting Deputy Assistant Secretary for Budget, DHHS.

Purpose of Hearing: This hearing was the third NIH fiscal year (FY) 2003 appropriations hearing and the second of five theme hearings.

Summary

The hearing started with each director's opening statements in regard to the future of biomedical research. All aspects of the grant process were covered from instrumentation and equipment by Dr. Vaitukaitis to the peer review selection process by Dr. Ehrenfeld. Dr. Nakamura also discussed information dissemination.

Questions

Representative Regula

• The Congressman asked if research was performed just for research sake and how the institutes decide which research to fund. Dr. Kirschstein responded that each institute has its own criteria.


• Mr. Regula asked what kind of research NIGMS performed and how it translated to affect the public. Dr. Cassman responded that NIGMS concentrates on the basic processes of science including enzymes and biochemistry at the cellular level. He used a yeast study as an example of how basic research on an organism can translate into an effective treatment for the public. Dr. Cassman also stated that most research programs are investigator initiated, and that is how research projects are decided. Dr. Cassman further explained that all institutes have an in-house (intramural) research program except for NIGMS and NCRR and Request for Applications set certain scientific boundaries or paramaters on research topics. Mr. Regula asked the number of current research projects NIH is funding. Dr. Kirschstein reported that there were currently 30,000 total NIH grants.


• Mr. Regula asked if each director conducted peer review. Dr. Cassman responded that through the advisory boards, institute directors do participate in review.

Representative Obey

• Mr. Obey reported that the President's Budget supports a 16 percent NIH increase but only a 3 percent National Science Foundation increase. The smaller increase seems to be the same for the other agencies and he is concerned about the balance in resources allocation. He asked if there was collaboration of research among agencies. Dr. Kirschstein responded that there are enormous linkages and much of the equipment used in biomedical research came from advances in basic scientific fields such as physics and chemistry.


• Mr. Obey asked the panel to clarify the differing positions between NIH and the Agency for Healthcare Research Quality (AHRQ) since the latter was receiving a 16 percent cut in the President's Budget. Dr. Kirschstein reported it is important to study the outcomes of research which is AHRQ's purpose, and that 75 percent of AHRQ's budget comes from the NIH's budget in the evaluation channels.


• Mr. Obey reported that in the early 70's, when there were massive increases for the National Cancer Institute, the number of grants increased as well as the staff for peer review. He wanted to know if the same was happening all over NIH with the large budget increases. Dr. Kirschstein replied that the number of program offices has gone up. Dr. Ehrenfeld added that there are new programs since the doubling effort started, including bioterrorism and massive regulation and oversight which require greater program office support.


• Mr. Obey then questioned the $105 million earmark in the President's Budget for a Level IV facility at Ft. Dietrick. He also asked for clarification on the title "Level IV." Dr. Kirschstein gave a history of how NCI obtained the facility and replied that she didn't know if the Army was still going to pay part of the cost for the facility. The answer would be submitted for the record.

Representative Hoyer

• Mr. Hoyer welcomed the group and brought up the payline issue. He reported a 32 percent payline and asked if the quality of the science applications had gone up. Dr. Ehrenfeld reported that the bottom half of all research applications are not discussed but the number being unfunded is decreasing. Both the CSR and NIH Directors reported that level of science is increasing so rapidly and only one out of three applications is funded. Mr. Hoyer then asked if the greater sum of money going to the NIH is being digested effectively. A resounding, "yes" response was heard from the panel.


• NIMH was next questioned by Mr. Hoyer. He asked Dr. Nakamura if neuron loss can be predicted in schizophrenia . The doctor replied that the key role of NIMH is to prevent the disease, as there is no cure. Mr. Hoyer then mentioned the decline in children's illness research and asked if NIMH had developed a plan to combat this issue. Dr. Nakamura replied positively and stated that more collaboration is necessary from mental health professionals, as systems of mental illness are tough to detect in children due to their varying stages of animosities.


• Mr. Hoyer then asked about the Loan Repayment Program (LRP) to see if only NIH researchers are eligible to apply. Dr. Kirschstein responded that in Fiscal Year 2003, the dollars available for the LRP will double.

Representative Kennedy

• Mr. Kennedy asked the panel to discuss health insurance discrimination in regard to mental health diseases. Dr. Kirschstein responded that was an issue for the Center for Medicare and Medicaid (CMS). Dr. Battey concurred that mental health causes physical problems and should be covered by health insurance plans. Mr. Kennedy expressed frustration about the NIH dollars spent on mental health research in relation to what is spent on AIDS and cancer research. Dr. Ehrenfeld replied that most grants are investigator initiated, and applications are not as dominate for the areas Mr. Kennedy was discusssing. Dr. Nakamura commented that there were not enough researchers in the mental health arena.

Representative Sherwood

• The area that interested Mr. Sherwood was the discrepancy between drug approval and its treatment for patients. He stated that NIH needed to promote drug findings. Dr. Hanson replied that the field of general neuroscience needs to partner with institutions more to alleviate this issue.


• Mr. Sherwood then expressed concern about young people's health and science education programs. He stated that the NIH needed to have an office of science education for the intramural and extramural programs.


• Mr. Kennedy then followed up by stating that NIH needs to make better use of the funding through more prevention treatments. Dr. Kirschstein agreed, stating that the young population is unhealthier than ever. Mr. Kennedy then asked NIGMS about their role in behavioral research. Dr. Cassman replied that his Institute's role was in the fundamental biological processes and drug interactions. The Congressman replied that he would like a more detailed description of the NIGMS function for the record.

Following that discussion, Mr. Obey addressed information dissemination. Dr. Kirschstein told the Chairman that information is distributed mainly through pamphlets. Mr. Obey then asked Dr. Ehrenfeld to describe the method for scientific review. She stated that there were clusters of study sections based upon each reviewer's area of expertise.

Mr. Kennedy and Mr. Sherwood followed Mr. Obey with questions regarding the goals of the Secretary of HHS and managed care. Mr. Weems replied to the Congressman that the goal of the Secretary is to leverage all the agencies including NIH, CDC, HRSA to move into the community. The behavioral research question proceeded to come up. and Mr. Kennedy reported that prevention research has worked in Rhode Island. Dr. Hanson replied with a smoking example, saying that people want to quit smoking but are addicted to it. It is the NIH research on genetics and addiction that are working to prevent people who are more susceptible to addiction from taking up the habit.

Prepared by Office of Budget, March 20, 2002