108th Congress

FY 2004 Appropriations Overview—Day 1—Hearing Before the House Appropriations Subcommittee on Labor, HHS, Education

April 2, 2003

Members Present

Representatives Ralph Regula, (R-OH), Chairman; C. W. "Bill" Young (R-FL), Chairman, House Appropriations Committee and ex-officio Member of the Subcommittee; David R. Obey (D-WI), Ranking; Roger F. Wicker (R-MS); Anne Northup (R-KY); Randy "Duke" Cunningham (R-CA); Don Sherwood (R-PA); Dave Weldon (R-FL); Michael K. Simpson (R-ID); Steny H. Hoyer (D-MD); Rosa DeLauro (D-CT); Jesse L. Jackson, Jr., (D-IL); and Lucille Roybal-Allard (D-CA).

Witnesses

Dr. Elias Zerhouni, Director of NIH, accompanied by Drs. Andrew von Eschenbach, Director of NCI; Anthony Fauci, Director of NIAID; Raynard Kington, Deputy Director of NIH; Allen Spiegel, Director of NIDDK. Also present were Drs. Ruth Kirschstein, Senior Advisor to the NIH Director; Patricia Grady, Director of NINR; Richard Hodes, Director of NIA; Donald A.B. Lindberg, Director of NLM; John Ruffin, Director of NCMHD; Paul Sieving, Director of NEI; Stephen Straus, Director of NCCAM; Lawrence Tabak, Director of NIDCR; Judith Vaitukaitis, Director of NCRR; and Mr. Donald Poppke, Associate Director for Budget.

Purpose of Hearing: The purpose of the hearing was to present to the Subcommittee the elements of the Fiscal Year (FY) 2004 NIH budget. The essence of the NIH presentation was to describe what health benefits have resulted from the Nation's longstanding investment in the NIH, particularly the doubling effort that occurred from FY 1999 through FY 2003, and NIH's plans for responding to the health challenges beyond.

Summary:In general, all the opening remarks made by the Members were supportive of NIH. Mr. Regula pointed to the doubling but said that, "we are interested in results..how's the American public being served by this doubling of the budget of NIH," a theme echoed by other members of the Subcommittee. Mr. Obey opened by stating that he couldn't say anything good about the proposed budget for NIH. He also spoke about the huge increase provided by the doubling, but cautioned that, "we are now going to hit a plateau and we run the risk of not building on what it is we've been trying to create in the first place," and indicated that sufficient funding would be more difficult because of "an almost mindless insistence on putting tax cuts ahead of everything else in this society."

Statements of Witness: Dr. Zerhouni provided the only testimony for the hearing and began with charts depicting what would have happened if research had not altered the normal progression of certain diseases. He then turned to the "Roadmap," whose goal is a short list of the most compelling initiatives that the NIH should pursue that would make the biggest impact on biomedical research. Three major themes emerged:

• uncover new pathways to scientific discovery, by developing a comprehensive understanding of the building blocks of the body's cells and tissues and how complex biological systems operate, using tools such as molecular libraries, nanotechnology, computational biology and bioinformatics and molecular imaging.
• the changing dynamics of the research teams of the future, which will need to be integrated teams of specialists from numerous disciplines that were considered unrelated in the past, such as imaging.
• the need to re-engineer the national clinical research enterprise for optimal translation of our discoveries into clinical reality.

Questions:

Representative Regula:

• He did not ask any questions but only commented at the outset that he was interested in knowing how the public is being served by the doubling of the NIH budget.

Representative Wicker:

• He thanked the Director for visiting his home state and the site of the Jackson Heart Study. He asked Dr. Zerhouni to comment on the reasons for the study and its progress. He also thanked NIH for holding the first NIBIB planning meeting in Mississippi and asked Dr. Zerhouni to talk about bioimaging for the future. He asked his opinion of the University of Mississippi's Natural Products facility.
• When a cure for diabetes is found, will it be an all-at-once event, or will understanding be incremental?

Representative Roybal-Allard:

• She asked what NIH research means to her constituents, particularly the roadmap element of re-engineering clinical research. Is there a set-aside to fund this initiative, and if so, is it enough?

Representative Simpson:

• He noted at the outset that he and Dr. Weldon plan to visit the NIH shortly. He then asked, as a dentist, about new research by NIDCR on the use of saliva as a research tool. Mentioning that his father had died from complications due to diabetes, he asked how close NIH is to a cure for the disease. Is obesity the major cause of Type II. diabetes?

Representative Jesse Jackson, Jr.:

• He encouraged NIH to address health disparities, then asked about the status of the strategic plan and how NCMHD could be strengthened. He asked again for any recommendations to the Committee that could make the Center stronger; how the Center works with the other NIH ICS.
• He described the five priorities stated in the enacting legislation–development of a health disparities budget, establishment of the endowment program, annual report to Congress, creation of a centers of excellence program, and a loan repayment program, and asked how the Center has addressed these.

Representative Sherwood:

• He noted that he represents a district with a largely rural and pretty aging population, and that rural areas across the nation have a particularly difficult time attracting and retaining healthcare providers. And he said he was concerned that health care could be taking a huge step backwards there. What sort of analysis has the center for Minority Health and Health Disparities has done on rural access to healthcare and what are your thoughts?

Representative DeLauro:

• In the case of a biological attack on the U.S., she asked if the current system of a limited number of secure (BSL-3/4) laboratories nationwide was sufficient or would research be delayed. She said it appeared there is an obvious gap, and asked for comment on the number of secure (BSL-4) laboratories, and what the FY 2004 budget would do for this.
• Noting her long-standing interest in ovarian cancer and the lack of a reliable screening test to detect this condition early enough for treatment, she asked how close is NIH to developing such a test. How long before a test is available to patients?

Representative Weldon:

• He also mention his enthusiasm to visit the NIH with Representative Simpson. As a physician he described his experience with AIDS drugs which, while reducing morbidity and mortality, carry a huge price tag, as high as $20,000 annually. Does NIH invest any dollars in looking at the cost-benefit of any of these pharmaceutical treatments. The AIDS treatment program ADAP allows only $6,000 per year. What is NIH doing? It appears that NIH does not devote a great deal to development nor look at cost-benefit. Is this true? Should we redirect some of your dollars to figure out how to pay for drugs? Does NIH make recommendations to HRSA, and others?

Representative Northup:

• Considering the proposals in the roadmap, is NIH finding it difficult to change an entrenched organization? Are well-funded organizations unwilling to cooperate?
• In collaborative efforts are there boundaries within schools, between institutions, different institutions?
• When you make "glue grants" do all institutions share in the funding?
• Many disease groups compare the amount of funding per patient for diseases, particularly AIDS. Many diseases are directly affected by research on the human genome. Can you help us clarify to the disease groups that it is impossible to break down every dollar? Yet on the other hand, isn't it true that NIH awards are made to capitalize on opportunities where there is a good chance for a breakthrough? Therefore, it appears that the "rich get richer" and diseases like "autism never begin to progress."

Representative Cunningham:

• He thanked Dr. von Eschenbach for his help with the Town Hall meeting on prostate cancer held in the District of Columbia in concert with Mayor Anthony Williams, and noted that there would be another this year.
• He said he would submit questions for the record on ocular albinism, tuberous sclerosis, and spinal muscular atrophy. But, he said, he did not believe the Committee should direct "where research should go."

Prepared by Anne Houser, OD/OLPA
April 7, 2003