107th Congress

Biomedical Advances -- Hearing Before the Senate Committee on Health, Labor and Pensions -- May 10, 2001

Members Present:

Present for all or part of the hearing were: James JeffORDs (R-VT), Chairman; Edward M. Kennedy (D-MA), Ranking Member; Senator Tim Hutchinson (R-AR); Senator Hillary Rodham Clinton (D-NY); Senator Jack Reed (D-RI); Senator Christopher Dodd (D-CT); Senator Paul Wellstone (D-MN); Senator Patty Murray (D-WA).

Witnesses:

Panel One: Former U.S. Senator Mark Hatfield; James and Julianne Nickerson, American Heart Association; Arthur Ullian, President, National Council on Spinal CORD Injury.

Panel Two: Dr. Robert Topel, University of Chicago; Dr. Kenneth Keller, University of Minnesota; Dr. Sam Silverstein, Funding First Board Member, Research America.

Summary:

Purpose of Hearing:

The Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education convened this hearing to learn about current biomedical research opportunities and the health and economic consequences of the nation's investment in biomedical research.

Opening Statements:

Both Senators JeffORDs and Kennedy made formal opening statements. In their remarks, the Senators discussed the importance of biomedical research and the unprecedented pace of discoveries in recent years, such as the sequencing of the human genome. Both Senators expressed enthusiasm for a recent study (supported by the National Institute on Aging) that reported the number of chronically disabled older adults in the United States has declined. Senator Kennedy, in particular, was optimistic that the disability decline could have positive implications for future financing of the Medicare program.

Statements of Witnesses and Questions:

Panel One

Former Senator Hatfield spoke in his capacity as the Chairman of Funding First, an organization that advocates for biomedical research funding. He discussed some of the recent medical advances investigators at the Oregon Health Sciences Center have developed and the positive economic benefit NIH funding has had in Oregon. He urged Congress to continue its efforts to double the NIH budget by 2003-particularly given the number of emerging promising findings being pursued on diseases and conditions such as Alzheimer's disease and osteoporosis. He also asked that Congress consider increasing funds for other science agencies so that math and science are not neglected.

Ms. Julianne Nickerson discussed her son James' rare congenital heart condition and the outstanding care he has received. James, who is only seven years old, is doing well and has a bright future. She thanked the Committee for its support of NIH funding and urged the NIH to make heart disease a top research priority.

Mr. Arthur Ullian discussed the results of a recent study in which investigators at Duke University documented the declining rate of disability for people 65 years and older in the United States. Most striking, he noted, is the dramatic decline in disability rates for African Americans. Findings from other studies, conducted by the same investigators, suggest that the number of individuals suffering from dementia is also declining. Mr. Ullian stated that the potential policy implications of these declining rates of physical and mental disability are numerous, including solvency of the Medicare program and improvements in the nation's economy due to increased productivity.

Questions:

Senator JeffORDs asked Senator Hatfield how Congress could help balance the interests of other areas of science with that of biomedical research. Senator Hatfield urged Congress to treat all areas of science equally and to recognize how interconnected the disciplines are. Empathizing with the demands facing Members of Congress, Senator Hatfield acknowledged they do not have enough time for oversight activities. Thus, he endorsed Senator Specter's proposal of creating a citizen's audit to help Congress scrutinize the Federal grants process.

Senator Wellstone commended Mr. Ullian for his testimony, stating that it exemplifies why supporting biomedical research is important for both humanity and the economy. He cited Duchenne Muscular Dystrophy as an example of a disease that needs more attention because of its particularly cruel nature. Senator Reed expressed his support for fully funding the Centers for Disease Control and Prevention and graduate medical education programs. Senator Hatfield urged the Committee to support nutrition research at the U.S. Department of Agriculture. He also urged them not to expect immediate results from research. Research should be viewed as a long-term investment, and good results take time to produce. Senator Reed agreed with Senator Hatfield, noting that the disability decline in older people is a good example of how a long-term investment in research can generate good outcomes. Mr. Ullian stated that the Committee could expect future results from this study since the work is ongoing.

Panel Two

Dr. Topel described medical research as a worthwhile investment because it is a public good. In his work as an economist, Dr. Topel has quantified the levels of investment that would be necessary to cure diseases such as cancer and heart disease ($47 and 48 billion respectively). Dr. Keller discussed the importance of multi-disciplinary research and how interactions among different sciences can expedite new advances. He stated that NIH faces a challenge trying to engage all of the sciences simultaneously. Dr. Silverstein stated that the size of our nation's investment in research would determine the speed at which new advances occur. The continued investment in research will also help attract young people to careers in research. He expressed his support for academic health centers, stating that the program helps to ensure that research findings are translated into practice.

Questions:

Senator JeffORDs asked Dr. Topel if there is an optimal funding level for medical research. Dr. Topel acknowledged that there is an optimal level of funding, but he cannot say what it is-however, it is bigger than it is now. Senator JeffORDs asked Dr. Keller for his opinion of Senator Specter's idea to establish a citizen's audit process. Dr. Keller responded that a citizen's audit process is a good idea. However, in his opinion, the audit won't address his underlying concern that the current NIH structure is not conducive to supporting multi-disciplinary research. Instead, it is designed to support researchers who are interested in particular diseases and conditions. He is hopeful that the new National Institute of Biomedical Imaging and Engineering will help address his concerns by becoming a model of how interdisciplinary research can be supported by the NIH. Dr. Silverstein expressed his support for the NIH peer review process, which holds investigators accountable and ensures that the best research is supported. An under-appreciated fact about the NIH, he feels, is investigators across the nation are conducting NIH-supported research.

Senator Clinton articulated her support for funding the NIH and programs that support medical infrastructure, such as graduate medical education. She also expressed her interest in environmental health and asked Dr. Silverstein how more research into environmental health could be stimulated. Dr. Silverstein suggested encouraging more research to identify biomarkers for dangerous toxins and to support research into developing effective vaccines.

Senator Reed asked what could be done to attract people to research and to address the involvement of children in research. Dr. Silverstein suggested that incentives, such as loan repayment programs and the expansion of MD/PhD programs, would be useful. Regarding the involvement of children in research, Dr. Silverstein said that it is imperative to provide the public with information about the promise research holds.

Prepared by Mary Jo Hoeksema, NIA