107th Congress

Testimony NIH Oversight

Elias Zerhouni, M.D.
Director, National Institutes of Health
October 9, 2002

NIH Oversight

Good morning, Mr. Chairman and members of the committee. Thank you for inviting me to testify about the nation's investment in medical research. This is my second appearance before this committee, and my goal this morning is to address some of the questions that you and NIH's many stakeholders have posed.

Thanks to the generous and bipartisan support of the Congress, this Administration, and, of course, the American public, we are approaching the completion of the five-year plan to double the NIH budget. As we consider future funding options for NIH research, we must again ask the question: "What value do we place on the health of the American people and, at a time of unprecedented globalization, all of humanity?"

I believe that there is nothing of greater value than our public health. It is the foundation of our society. Good health may be our greatest asset. Poor health is one of our greatest fears. In fact, there are rising national security concerns today about weapons fashioned from the agents of human disease.

I can assure you that resources invested in the NIH are well spent. It is often difficult, in the short-term, to precisely identify the return on the investment in research because of the long horizon from a laboratory discovery to the application of a new treatment to a patient. Nevertheless, the taxpayer must and should hold us accountable to the effect of the growing NIH budget on people B is this national investment actually reducing the burden of illness on ourselves and our families?

One way to answer this question is to compare the current burden of illness to what the burden might have been if the nation failed to invest public funds in medical research.

• For example, suppose the nation had not invested in HIV/AIDS research and trends started in the 1980s had been allowed to continue? Today, our hospitals would be literally filled with HIV/AIDS patients. And had NIH contributions not been realized, today the death rate from HIV/AIDS would be five times higher, in the U.S. alone.
• Coronary heart disease provides another dramatic example of the effect of research on reducing the burden of disease. In the year 2000 alone, there were 815,000 fewer deaths than there would have been if medical care had not advanced since 1975. NIH research contributed substantially to these dramatic results.
• The development of the Haemophilus influenza type B (Hib) vaccine by NIH researchers dramatically reduced the incidence of serious childhood infections from Hib B a bacteria that used to be a major cause of meningitis and neurological damage.
• The development of improved diagnostic tests for HIV and for hepatitis B and C by NIH researchers reduced risk of post-transfusion hepatitis from 23 percent to 0.31 percent. As a consequence, today's blood supply is much safer.
• This year alone there will be almost a quarter million fewer deaths from stroke than there would have been if we had not invested in NIH research.

These few illustrations from the past can provide a glimpse at the expected research outcomes of the future. Let me give you just a few examples of the many new and expanded initiatives that were only possible because of the doubling effort and some of the early outcomes from these innovations:

• During the doubling of the NIH budget, the draft sequence of the human genome was published in 2001 B ahead of time and under budget because we were able to invest in greatly improved DNA sequencing technology. Doubling NIH funds also contributed to the recent sequencing of the mosquito genome, which will help in our fight against malaria.
• Budget increases also supported the study and manufacture of candidate vaccines- today NIH has more than 50 vaccines in development, 15 of which are in or nearing the clinical trial phase.
• Doubling funds supported phase I clinical trials for dengue virus vaccines, which is a member of the same family of viruses as the West Nile Virus. NIH' dengue virus program enabled the development of a candidate West Nile virus vaccine, which will start being tested next year in record time.
• Although the NIH established the Specialized Programs of Research Excellence (SPOREs) more than five years ago, the doubling of the budget enabled NIH to expand this initiative from 3 cancers to 13 and from 10 programs to over 30. SPORE researchers have recently confirmed that variations in the molecular profiles of different types of breast tumors can yield important clues about the prospects for relapse and long-term patient survival.

• The number of clinical trials designed to specifically determine the benefits of particular prevention, diagnostic, or therapeutic advances have grown due to the doubling of the NIH budget. Currently, more than 4500 NIH-funded clinical trials are listed on ClinicalTrials.gov- more than 2500 of these trials are still recruiting patients. As a recent example, the NIH Women's Health Initiative, which has been following 200,000 women, has shown that, contrary to expectations, a widely believed effective hormone replacement therapy may have deleterious consequences such as heart disease and breast cancer.
• And NIH efforts to address minority health and health disparities have increased as a result of the recent growth in our budget. We are now supporting research training for under-represented minority researchers; educational loan repayment programs to attract health professionals from disadvantaged backgrounds to clinical research; activities to develop cultural competency among health care providers and others that participate in health care processes; and building a strong science infrastructure in minority institutions.
• As importantly, doubling funds have been devoted to expanding the capacity to conduct clinical research that is vital to the translation of knowledge to better health. From 1999-2003, we will have more than quadrupled the number of young physicians engaged in clinical research, from 220 to 992.
• Doubling funds also gave the NIH the ability to expand its public education and outreach activities B activities that also improve and lengthen lives. For example, in the area of low vision, which affects more than 3.4 million older people in the U.S., funds were used to develop and launch a traveling exhibit designed to increase public awareness about low vision and its early diagnosis. The exhibit has been seen by 13 million people. Similarly, in 2000, we prevented the deaths of more than 3500 infants as result of our campaign to tell parents and care givers that positioning an infant on his/her back lessens the chance of sudden infant death syndrome (SIDS).

We believe Federal investments in biomedical research also stimulate additional investments by private sector. For example, R&D spending by PhRMA members exceeded the NIH budget for the first time in 1991. The doubling of the NIH budget has catalyzed new construction and renovation by U.S. medical schools with a three-fold increase in capital investment from1990 to 2007.

Public investment in medical research also supports hundreds of thousands of jobs at universities, academic health centers, and small and large companies across the county. Investment in the NIH has stimulated the growth of a highly educated and highly trained workforce. Over the past 20 years, the number of Ph.D. faculty in U.S. medical schools has grown by 88 percent.

Up until now I have articulated the many benefits- health and economic- that have been the result of the public's investment in the NIH. But where do we go from here?

In the next decade and beyond, with the goal of continuing to substantially improve the length and quality of American lives, the NIH must continue to advance science and further enable science to advance. Recently, I have been conducting a series of meetings with internal and external scientists to develop a "road map" for the future. The goal was to develop a short list of the most compelling initiatives that the NIH should pursue over the next three to five years that will make the biggest difference in biomedical research and in health. The initiatives will cut across NIH institutes and centers and integrate multiple disciplines. They will also resonate to the needs and concerns of the public. Common themes are emerging, including re-engineering clinical research, new pathways to discovery, the science team of the future, and revolutionary technologies.

I hope to continue to convince you that the NIH is a good investment. For most of the previous 30 years, 0.12 - 0.15 percent of the Gross Domestic Product (GDP) was devoted to NIH research. Based on our estimates, that number has risen to 0.25 percent- or $94 per American per year, including our new biodefense mission. (Figure 8) The NIH budget remains a relatively small share of national productivity, especially given the rising impact of health issues on our society.

As we look to the future, it is important to remind ourselves that the general health of the population is improving and disability is declining. In 1925, life expectancy at birth was only 59 years; in 1950, it was 68.2 years; in l975, it was 72.6 years; and by the year 2000 it was almost 77 years. (Figure 9) Moreover, disability rates in the elderly U.S. population declined from approximately 26 percent in 1982 to 20 percent in 1999. This means that people are not only living longer but they are also living better quality lives.

But, as a physician with some experience in helping oversee a large academic health institution, I am all too familiar with the limits of our current approaches to medicine. I am convinced that we need to accelerate fundamental discovery and translation of that new knowledge into preventive and therapeutic strategies, if we want to have any hope of continuing to lengthen and improve the quality of our lives and the lives of our children and our children's children. Even though we have made great progress, new threats are emerging, such as West Nile virus and rising rates of obesity, diabetes, and Alzheimer's disease.

I began my testimony by projecting what life would look like today had the nation not had the vision to invest in medical research many years ago. Congress and the Administration have seen fit to continue to invest in this public good. I am confident that we can continue on this path of unparalleled success.