107th Congress

1FY 2002 Appropriations on Lifespan -- National Institutes of Health Theme Hearings -- House Appropriations Subcommittee on Labor, HHS, and Education -- April 4, 2001

Members Present

Representatives Ralph Regula (R-OH), Chairman; Rosa DeLauro (D-CT); Kay Granger (R-TX); Steny Hoyer (D-MD); Jesse L. Jackson, Jr. (D-IL); Nita Lowey (D-NY); Anne Meagher Northup (R-KY); Nancy Pelosi (D-CA); John Peterson (R-PA); and Don Sherwood (R-PA).

Witnesses

Dr. Ruth Kirschstein, Acting Director, National Institutes of Health (NIH); Dr. Richard Hodes, Director, National Institute on Aging (NIA), Dr. Duane Alexander, Director, National Institute of Child Health and Human Development (NICHD), Dr. Kenneth Olden, Director, National Institute of Environmental Health Sciences (NIEHS), Dr. Patricia Grady, Director, National Institute of Nursing Research (NINR).

Mr. Regula welcomed Dr. Kirschstein and her team and called the meeting to order.

Dr Kirschstein provided a few brief remarks. She explained that the team consisted of two panels; the first panel would discuss the topic of Life Span. Life span encompasses infancy (prenatal) to older people. The goal is to enable productive safe lives and have good care as needed. The mission of the four Institutes (ICs) presenting fits in very well with the life span theme.

Mr. Regula asked if life span cuts across every discipline. Dr. Kirschstein replied that yes, it does. It was a difficult decision but given the limitations, all ICs could not be present.

Opening Statements

Dr. Alexander, NICHD, said that NICHD was the first IC established to address life span issues. The founding concept still applies: the key to understanding, ameliorating, and preventing mental retardation and many of the developmental disorders and diseases of childhood and adulthood lies in studies of the process of development. From research many discoveries have been made to include vaccines and medical care improvements that have reduced this Nation's infant mortality rate by 70 percent. He also stated that prenatal experiences impact conditions in adult life.

Mr. Regula:

NICHD. Mr. Regula asked if this includes listening to music while pregnant? Dr. Alexander replied, no, some disorders have their origins in the experiences of the mother and fetus during pregnancy. Dr. Alexander indicated that complications during pregnancy and at delivery could portend a lifetime of problems for both mother and child. Several areas of focus include ascertaining causes of premature labor, developing and improving fetal surgery, and a longitudinal study focused on how children learn, translating that into teaching to improve their ability to read. Learning to read is one of the most significant life span predictors not only of academic and economic success, but of health and social behavior as well.

Mr. Hoyer:

NICHD. Mr. Hoyer stated that he has been working with Carmela Walgren on a program that deals with learning programs for children. He asked that Dr. Alexander explain the program and give a little background. Dr. Alexander explained that the program is studying learning in normal children and those that are challenged to determine how they can best be taught. Clinical trials in the classroom have had positive results: those reading below the 10th percentile, tested above the 50th percentile after intervention.

Mr. Hoyer stated this is so important. The results imply that even those most challenged can compete. Mr. Hoyer asked Dr. Alexander to describe the successes in this area. Dr. Alexander explained that they had repeat success. In the study they went into schools in the District of Columbia and other places (poor performing schools), and taught the teachers these methods so they could use them in the classroom. In all schools the children were brought from below the 10th percentile to above the 50th percentile

Mr. Regula requested Dr. Alexander return to this subject once more Members were present, as this is extremely important as well as fascinating.

NIA. Dr. Kirschstein presented Dr. Hodes of the National Institute on Aging next as representing the other end of life span.

Dr. Hodes, NIA, in his opening remarks stated that the nation is in the midst of change in age profile. Life expectancy had improved from an average of 49 years in 1900 to 76 years at the turn of the 21st century. In addition, improvements in life quality have been observed. Promising news, the decline in observed rate of disability for people 65 and older was displayed in a chart for the members. NIA is supporting research to develop interventions to prevent instead of react to a disability. Dr. Hodes also discussed efforts underway for addressing Alzheimer's disease (AD) with which four million Americans 65 and older are afflicted. Recent findings have identified a number of genetic and non-genetic AD risk factors. A breakthrough experiment last year showed that a vaccine could stimulate an immune response in mice. A chart was shown to depict the results from the mice experiment.

Mr. Hoyer:

NIA. Mr. Hoyer asked Dr. Hodes to clarify if in the research done on transgenic mice they were able to reverse the mice's inability to memorize. Dr. Hodes replied that using mice with similar brainpower, when treated at a later stage, there was a reversal of lesions.

Ms. Northup:

NIA. Ms. Northup stated that NIH and NIA have received large increases over the past 3 years. She asked how much of that increase has gone to research in Alzheimer's disease (AD). Dr. Hodes replied that they were spending about $520 million annually. He said the increase is in rough proportion to the overall increase of NIH.

Ms. Northup stated that a group of constituents suggested that the funding should be doubled to get it up to $1 billion. Constituents stated that if they had the $1 billion, we could cure it and then would never have to treat it again. She then asked if this were true. Dr. Hodes responded that he wished it were true. In fact, studies are looking at several ways to treat AD because it is not known which approach is most promising.

Ms. Northup then added that groups are being informed that we know how to cure these diseases if we would just write a check we could develop the cure, but clearly we can't. She then asked where that information is coming from. Dr. Hodes replied that as was stated at the hearing the previous day, NIA is supporting so many different trials because we don't know which method will work.

Ms. Pelosi:

NIA. Ms. Pelosi stated that a number of our forefathers lived to be quite old. She then asked what we mean when we say we have expanded the life span. Dr. Hodes replied that the average (49 in the 1900s) skews the view of life span. In the early 1900s there were many deaths at an early age, which brings the average down, whereas now there aren't nearly as many early age deaths.

Mr. Hoyer:

NIA. Mr. Hoyer stated that Dr. Hazeltine spoke at their bipartisan retreat and directed comments to colleagues with younger children. He said that the children of these Members could expect to live to be 100 and their children could expect to live to be 110. He stated that the Members were all amazed, and he asked if Dr. Hodes would comment. Dr. Hodes replied that predictions of the extreme are controversial, but he noted that we used to have only 100,000 people at the age of 85 and that we now have 4 million at that age.

Ms. Pelosi:

NIA. Ms. Pelosi asked if individuals will live longer or will the quality of their lives be better. Dr. Hodes responded that for most people, wanting to live a long life is directly related to how they live it.

Opening remarks continued:

Dr. Grady, NINR, provided opening remarks next. She said that NINR addresses a broad array of life span issues - from low birthweight babies to older people who wish to extend the quality and length of their lives. She gave three examples of ongoing studies they support. The first was on low birthweight when registered nurses make home visits to targeted low-income African American pregnant women. Results indicated a decrease in the low birthweight rate so investigators have now expanded the study to include Hispanics. The second example given was on the emphasis to prevent or manage illnesses for teens and adults such as type 2 diabetes in American Indians. The last example described research using a transitional care model for older people so they can live healthy lives at home as long as possible.

Dr. Olden, NIEHS, was the last to provide opening remarks. He stated that the work done at NIEHS examines environmental influences on every stage of life. Most chronic diseases in humans arise from a complex array of factors, which could include several genes, environmental conditions or exposures, age, nutritional status and other predisposing factors. He used an analogy of a loaded gun for the relationship between genes and the environment. A loaded gun by itself causes no harm, only when the trigger is pulled. Likewise, one can inherit the predisposition to have a disease but never have the disease unless exposed to the environmental trigger. Dr. Olden pointed out that most chronic disease would not be fully understood until both the genetic and environmental contributions to their etiology are elucidated. He then showed three areas that were of top priority: susceptibility, exposure assessment, and testing.

Mr. Regula:

NICHD. Mr. Regula asked Dr. Alexander to repeat for the Subcommittee the part of his testimony on health and education as it was dynamite information and all should hear it. Dr. Alexander provided more detail on NICHD's efforts to study the process of learning to read by those who are regular learners and those with developmental problems. The study demonstrated in poor schools in DC and other areas (schools where students are reading below grade level) that a marked improvement in the ability to read resulted after the intervention (all schools tested above the 50th percentile and many were above the 70th percentile). Dr. Alexander noted that the control schools that independently employed the intervention did better as well. A panel concluded that the study demonstrated effectiveness in the classroom and recommended a scale up. The panel also recommended working on efforts earlier in life like at the Head Start age.

Ms. Northup:

NICHD. Ms. Northup stated that so much information from NICHD seems to be largely missed by the education community. She asked what is being done to get this out to our communities, as it just doesn't seem to be happening. She also stated that testing is so important and is quite expensive. She then asked how much it would cost to test all kindergartners in this screening program. Dr. Alexander responded that the screening is easy to use and score, and is really very cheap, probably less than $1 per child.

Ms. Northup then asked if NICHD would continue to make progress in research on learning/teaching techniques. She stated that we have to be sure that every reading program is science based, not market based. She then asked if NICHD would be looking around the country to make certain that reading programs are research based. Dr. Alexander replied that NICHD has made some efforts but needs to do more with publishers to let them know which information is research based.

Ms. Northup then stated that last year the Subcommittee became more involved in the early childhood programs, like Head Start and family literacy. She noted the need for more direction and a clearer idea of what works to convey to the families. She asked if NICHD is investigating this. Dr. Alexander responded that a solicitation is being prepared that will be funded in FY2002.

Mr. Sherwood:

NICHD. Mr. Sherwood asked how NICHD thinks we can best transmit this information on learning through the system. He asked for suggestions on getting to practical application. Dr. Alexander responded that they are working with the National Institute on Literacy and the National Reading Panel on what works. However, they need to work on teacher education, as what teachers have been taught is wrong. NICHD would like to see an in service training program to train teachers on what they need to do. This information has not effectively gotten to the local level. Additionally, more should be done with individual parents so they know what they can do at home.

Mr. Sherwood requested that Dr. Alexander forward to his office copies of the information that has made such a difference in student success so that he could add it to his arsenal.

Ms. Lowey:

NICHD. Ms. Lowey stated that she had observed in visiting schools, that the leadership of the individual schools could make the difference. She then stated that she was interested in working with Ms. Northup on this issue.

NINR. Ms. Lowey then moved to a different area, regarding early intervention in health and exercise. She stated that this effort has continued for 20 years and children are still engaging in unhealthy habits, eating junk food and not exercising. She asked Dr. Grady to elaborate on how we can do better on replicating success, getting the wORD out and changing behavior. Dr. Grady stated that we had made encouraging inroads but we need to get to the state and local level. She gave several examples-in North Carolina working with the Heart institute, to change behavior in school age children modifying school curricula. Another example was a self-help questionnaire for women with arthritis in the state of California.

Mr. Peterson:

NICHD. Mr. Peterson asked if he could have the reading materials to use to challenge both universities (that train teachers) and schools. He stated he would like to challenge every elementary school and university. Mr. Regula added that it should be sent to all Members. Mr. Alexander stated NICHD could provide materials. He added that they had worked with Penn State to bring in teachers from around the state for a workshop to highlight the findings.

Mr. Peterson stated that he was in the food business and that we have never had more information that gives guidance on food choices, yet people still make poor (unhealthful) choices. He asked how NICHD could help. Dr. Alexander replied that 8 of 10 deaths are behavior related and most have origins from childhood. But we don't know how best to intervene successfully. Dr. Alexander stated that we still have to learn which techniques work best at what ages to prevent smoking, unhealthy eating habits, etc.

Mr. Peterson stated that kids don't have the same routines as in his day. Many children and young adults don't have any idea of the risks they are taking. He also mentioned that, at one point in time, children were helping their parents quit smoking and drinking. He said that we must have been doing something right and asked Dr. Alexander to comment. Dr. Alexander responded that unfortunately now the only groups in which smoking is increasing is adolescent girls and that we need to try to counter these behaviors.

Ms. DeLauro:

NICHD. Ms. DeLauro stated that she saw Dr. Hodes testimony on CSPAN the previous night and commented that the work with Alzheimer's disease is terrific. She then asked Dr. Alexander if he was working with the state of Connecticut on their 1997 initiative on teaching teachers to teach. Dr. Alexander stated that much of their research comes from Yale, which has been an important contributor.

Ms. DeLauro stated that she would love to get teachers to come down to the Hill to show the Yale model. Ms. DeLauro then asked given what we know, hypothetically, if every child were part of a pre-K experience where you could employ these successful methods, what would the anticipated outcome be. Dr. Alexander responded that there would be greater success in reading levels. He then commented that these tested instruction methods don't cost more than the current methods, which are in some cases untested.

Ms. DeLauro then requested direction about what the Committee should consider with regard to teen behavior such as youth smoking. Several of the Members had just visited CDC where they were told that one of the major causes of serious illness is smoking. Ms. DeLauro asked who ought to be doing the research on how to address prevention and if it was a proper role for the Federal Government. Dr. Alexander replied yes. Dr. Kirschstein added that those results came from a study done by an NCI grantee. The data was so unexpected it was presented to the entire senior staff at HHS.

Ms. Pelosi:

NIEHS. Ms. Pelosi commented on the hearing held by the Subcommittee last year on children and the environment and the proposed longitudinal study to be done with CDC and other agencies. She then commented on a CDC study, which resulted in a fourfold reduction of secondhand smoke and stated that the environmental health issue is an important one.

Mr. Regula:

NIH-OD. Mr. Regula commented that Kent State is in his district and asked if someone could talk to the teachers about the successful learning program. He also asked if someone could come out and speak to a room of older folks. Dr. Kirschstein responded that NIH does that now and would be happy to address teachers or any other group with a Subcommittee Member.

Ms. Northup:

Ms. Northup commented that teachers in her district came to hear a speaker from NICHD about its programs in learning. There was strong disagreement on the usefulness of this new information between classroom teachers who were very supportive and the university representatives who were very resistant and uncooperative.

Prepared by OB