Special
Feature The
Disease U.S.
Defense
Senator
Mark
The United States has built an impressive biomedical research enterprise since the inception of the Marine Hospital Service over 200 years ago. Today the NIH [National Institutes of Health] is viewed as the premiere medical research center in the world. This special institution operates the world’s largest research hospital, employs nearly 3600 physicians and Ph.D. scientists, and supports biomedical research in nearly 1800 institutions throughout the world. Since World War II, better than half of the 100 scientists who have been awarded the Nobel Prize in Medicine and Physiology had prior support from, or experience at, the NIH before being honored. The NIH enterprise is touching the lives of millions of individuals in this country and abroad. Developments in treatments of disease and disorder are improving both the length and quality of life for people around the world and are saving money. Today vaccines protect children against diseases such as influenza, polio, measles, rubella, pertussis, and tetanus. Over the last 10 years, 9 improved or new vaccines have become available. Today, a new treatment for a certain type of high blood pressure is expected to reduce the incidence of stroke by one-third and result in 50,000 fewer heart attacks each year. This treatment costs 25 cents a day and could save $200 million each year in health care costs alone. Today, dramatic new developments in genetics and gene therapy offer hope to many suffering from disorders such as cystic firosis, cancer, and diabetes and skin diseases such as psoriasis and EB. Sustained support for research on the basic biological processes of health and disease has given birth to and nurtured the development of the biotechnology industry. In 1989, product sales in the biotechnology industry were approximately $2.9 billion. The industry is expected to contribute $60 billion to the world economy by the turn of the century. Federal support for this public/private partnership has been strong. Federal appropriations to the NIH more than doubled over the past decade, from $4,023,969,000 in FY ‘82 to $8,934,818,000 in FY ‘92. Every year during that period, Congress has appropriated funds to the NIH in excess of the request of the President. In 1991, it is estimated that the federal government supported 42 percent of health research and development, second only to industry at 47 percent. In 1992, it is projected that the NIH will fund 21,671 research/project grants and 706 center grants, the highest number in the institution’s history. In spite of this good news, I see fault lines forming in the pillars upholding the biomedical enterprise. The squeeze of federal fiscal constraints and competing budget priorities are pressuring its very foundation. Investigators are freling the squeeze in many ways: 1) The average number of new grants funded at NIH each year has fallen to below 6,000. Between FY ‘85 and FY ‘88, the NIH funded an average of 6,280 new grants each year. Since that time, the number of new grants have averaged less than 5,500; 2) The percentage of approved grants that receive funding has fallen over the last decade. In FY 1987 the NIH funded nearly 40 percent of approved grants. By FY 1992, only 29 percent of the approved grants are expected to receive funding; 3) Funded grants are being supported at levels below the amounts recommended after 3030
0.
Buildup Hatfield
scrutiny by the peer review panels. ations” on new grant awards have 3.2 percent in FY ‘80 to 15 percent grants for centers increasingly falls to keep pace with inflation.
These “downward negotigrown from an average of in FY ‘90; 4) Funding for below the level necessary
The research infrastructure is feeling the squeeze: 1) Instrumentation: Field surveys conducted by the National Science Foundation reveal that less than 20 percent of laboratory instrumen-
Repairing the faults that threaten the integrity of our biomedical enterprise will require nothing less than a mobilization of resources and resolve. It will require a reordering of national budget priorities from programs that destroy life to those that preserve and enhance life. -
tation is “state of the art,” and as much as 50 percent may be inadequate for current research purposes. The Packard! Bromley report documented nearly six years ago the obsolescence of university research equipment and evaluated the cost of renovation at $10 billion; 2) Facilities: Again, according to the NSF, nearly 40 percent of all research space is judged to be in need of repair in order to be used effectively. More than half of the research buildings on the NIH campus are from 30 to 50 years old. Many fail to meet current standards for safety, air conditioning, ventilation, and electrical service. According to the Director of the NIH, Dr. Healy, the Clinical Center on the NIH campus is in desperate need of repair. Renovation costs are estimated at $1.2 billion over a 17-year period. Replacement of the center, which she favors, would cost $1.6 billion. The NIH is no longer a major source of direct funding for extramural biomedical research facilities. The FY ‘93 budget proposed by the President includes $16 million for construction at minority institutions. The professional “opportunities” budget for the NIH recommends $290 million in FY ‘93 for extramural construction. The White House Science Council estimates that $10 billion is the necessary minimum over the next decade for university facilities construction and renovation; 3) Training: In a 1988 report, the National Academy of Sciences has estimated that
Senator Hatfield delivered this address at the dedication of the Biomedical Information Communications Center (BICC) at Oregon Health Sciences University in Portland, May 26, 1992. BICC is a central bank of medical information accessible to other hospitals electronically linked to the system.
NEWS & FEATURES
Vol. 6
September
1992
w.fasebj.org by Iowa State University Serials Acquisitions Dept (129.186.138.35) on January 23, 2019. The FASEB Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNum
the real growth in the research training program should be approximately 3.5% per year over the period from 1989 to 1993. The number of training grants has essentially been frozen since 1988 at less than 12,5000. The President’s FY ‘93 budget recommendation would support 12,240 trainees, well below the 14,742 recommended by the National Academy of Sciences’ report. The translation of basic research to clinical application and finally to patient care is feeling the squeeze. The NIH reports that over $280 million in clinical trials will not be initiated in FY ‘92 and FY ‘93 due to the lack of funds. In March, the Director of the National Institute on Deafness and Other Communication Disorders announced the institute’s intention undertake an initiative on Hearing Aid Development. Dr. Show reported that in view of what he described as “recent disappointments with the outcome of promising technologies,” the institute was moved to intensify its support of hearing aid research. However, no funds have been included in the FY ‘93 President’s budget for this initiative. Repair of these fault lines is essential if we are going to maintain the momentum established over the last 200 years. Without repair, we will slow the pace of research and miss important research opportunities. Opportunities such as: 1) Gene Therapy. Recent clinical trials show great promise in creating certain forms of cancer and severe immune deficiency; 2) Diabetes-which afflicts 14 million Americans. Scientists now believe that they have removed a major stumbling block to create an artificial pancreas; 3) Osteoporosis-a problem affecting an estimated 24 million Americans. Recent advances in techniques to study bone structure have furthered the development of a better understanding of the hormonal and other biochemical factors that hold promise for better therapies. Without repair, new investigators will become discouraged and leave the field as the percentage of approved grants funded each year continues to decline. Without repair, instrumentation and facility needs will go unmet, further slowing research progress. Without repair, the necessary pool of young trained investigators will not be available to lead this important endeavor into the next century. Without repair,
El
YES!
Please
we stand to lose our position as the world’s leader in biomedical sciences and technology. I recall that in President Reagan’s 1982 State of the Union Address, he stated: “The protection of our national security has required that we undertake a substantial program to enhance our military forces . . . A recogniton of what the Soviet empire is about is the starting point. Winston Churchill, in negotiating with the Soviets, observed that they respect only strength and resolve in their dealings with other nations. That’s why we’ve moved to reconstruct our national defenses?’ As a result, a substantial program of defense buildup was embarked upon by the Reagan Administration and the Congress. Military spending increased by $120 billion under the Reagan Administration; in fact, in 18 months the military spends on research and development what the NIH has spent since the turn of the century. In the past decade, United States military spending has more than doubled, from less than $130 billion in FY ‘79 to $300 billion in FY ‘89. Today we need to embark upon a disease defense buildup like that undertaken in the 1980s to respond to the preceived military threat of the Soviet’s. Repair of the faults threatening the integrity of our biomedical enterprise will require nothing less than a mobilization of resources and resolve. It will require a reordering of our nation’s budget priorities from programs which destroy life to those which preserve and enhance life. I am committed to this goal, but clearly we need to develop a broader constituency. Ultimately, the constituency I am talking about will be built only when we are able to make the clear connection between the intimately human needs of medical research and the cold confines of the budget process. When budget negotiators hammer out agreements, we deal with complicated calculations and endless reams of paper. We are isolated -- insulated -from human suffering and human needs. You must force us to deal with those human faces of suffering, and to be accountable for the trade-offs.
to
my 1993 subscription
enter
The
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Feature The
Disease U.S.
Defense
Senator
Mark
The United States has built an impressive biomedical research enterprise since the inception of the Marine Hospital Service over 200 years ago. Today the NIH [National Institutes of Health] is viewed as the premiere medical research center in the world. This special institution operates the world’s largest research hospital, employs nearly 3600 physicians and Ph.D. scientists, and supports biomedical research in nearly 1800 institutions throughout the world. Since World War II, better than half of the 100 scientists who have been awarded the Nobel Prize in Medicine and Physiology had prior support from, or experience at, the NIH before being honored. The NIH enterprise is touching the lives of millions of individuals in this country and abroad. Developments in treatments of disease and disorder are improving both the length and quality of life for people around the world and are saving money. Today vaccines protect children against diseases such as influenza, polio, measles, rubella, pertussis, and tetanus. Over the last 10 years, 9 improved or new vaccines have become available. Today, a new treatment for a certain type of high blood pressure is expected to reduce the incidence of stroke by one-third and result in 50,000 fewer heart attacks each year. This treatment costs 25 cents a day and could save $200 million each year in health care costs alone. Today, dramatic new developments in genetics and gene therapy offer hope to many suffering from disorders such as cystic firosis, cancer, and diabetes and skin diseases such as psoriasis and EB. Sustained support for research on the basic biological processes of health and disease has given birth to and nurtured the development of the biotechnology industry. In 1989, product sales in the biotechnology industry were approximately $2.9 billion. The industry is expected to contribute $60 billion to the world economy by the turn of the century. Federal support for this public/private partnership has been strong. Federal appropriations to the NIH more than doubled over the past decade, from $4,023,969,000 in FY ‘82 to $8,934,818,000 in FY ‘92. Every year during that period, Congress has appropriated funds to the NIH in excess of the request of the President. In 1991, it is estimated that the federal government supported 42 percent of health research and development, second only to industry at 47 percent. In 1992, it is projected that the NIH will fund 21,671 research/project grants and 706 center grants, the highest number in the institution’s history. In spite of this good news, I see fault lines forming in the pillars upholding the biomedical enterprise. The squeeze of federal fiscal constraints and competing budget priorities are pressuring its very foundation. Investigators are freling the squeeze in many ways: 1) The average number of new grants funded at NIH each year has fallen to below 6,000. Between FY ‘85 and FY ‘88, the NIH funded an average of 6,280 new grants each year. Since that time, the number of new grants have averaged less than 5,500; 2) The percentage of approved grants that receive funding has fallen over the last decade. In FY 1987 the NIH funded nearly 40 percent of approved grants. By FY 1992, only 29 percent of the approved grants are expected to receive funding; 3) Funded grants are being supported at levels below the amounts recommended after 3030
0.
Buildup Hatfield
scrutiny by the peer review panels. ations” on new grant awards have 3.2 percent in FY ‘80 to 15 percent grants for centers increasingly falls to keep pace with inflation.
These “downward negotigrown from an average of in FY ‘90; 4) Funding for below the level necessary
The research infrastructure is feeling the squeeze: 1) Instrumentation: Field surveys conducted by the National Science Foundation reveal that less than 20 percent of laboratory instrumen-
Repairing the faults that threaten the integrity of our biomedical enterprise will require nothing less than a mobilization of resources and resolve. It will require a reordering of national budget priorities from programs that destroy life to those that preserve and enhance life. -
tation is “state of the art,” and as much as 50 percent may be inadequate for current research purposes. The Packard! Bromley report documented nearly six years ago the obsolescence of university research equipment and evaluated the cost of renovation at $10 billion; 2) Facilities: Again, according to the NSF, nearly 40 percent of all research space is judged to be in need of repair in order to be used effectively. More than half of the research buildings on the NIH campus are from 30 to 50 years old. Many fail to meet current standards for safety, air conditioning, ventilation, and electrical service. According to the Director of the NIH, Dr. Healy, the Clinical Center on the NIH campus is in desperate need of repair. Renovation costs are estimated at $1.2 billion over a 17-year period. Replacement of the center, which she favors, would cost $1.6 billion. The NIH is no longer a major source of direct funding for extramural biomedical research facilities. The FY ‘93 budget proposed by the President includes $16 million for construction at minority institutions. The professional “opportunities” budget for the NIH recommends $290 million in FY ‘93 for extramural construction. The White House Science Council estimates that $10 billion is the necessary minimum over the next decade for university facilities construction and renovation; 3) Training: In a 1988 report, the National Academy of Sciences has estimated that
Senator Hatfield delivered this address at the dedication of the Biomedical Information Communications Center (BICC) at Oregon Health Sciences University in Portland, May 26, 1992. BICC is a central bank of medical information accessible to other hospitals electronically linked to the system.
NEWS & FEATURES
Vol. 6
September
1992
w.fasebj.org by Iowa State University Serials Acquisitions Dept (129.186.138.35) on January 23, 2019. The FASEB Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNum
the real growth in the research training program should be approximately 3.5% per year over the period from 1989 to 1993. The number of training grants has essentially been frozen since 1988 at less than 12,5000. The President’s FY ‘93 budget recommendation would support 12,240 trainees, well below the 14,742 recommended by the National Academy of Sciences’ report. The translation of basic research to clinical application and finally to patient care is feeling the squeeze. The NIH reports that over $280 million in clinical trials will not be initiated in FY ‘92 and FY ‘93 due to the lack of funds. In March, the Director of the National Institute on Deafness and Other Communication Disorders announced the institute’s intention undertake an initiative on Hearing Aid Development. Dr. Show reported that in view of what he described as “recent disappointments with the outcome of promising technologies,” the institute was moved to intensify its support of hearing aid research. However, no funds have been included in the FY ‘93 President’s budget for this initiative. Repair of these fault lines is essential if we are going to maintain the momentum established over the last 200 years. Without repair, we will slow the pace of research and miss important research opportunities. Opportunities such as: 1) Gene Therapy. Recent clinical trials show great promise in creating certain forms of cancer and severe immune deficiency; 2) Diabetes-which afflicts 14 million Americans. Scientists now believe that they have removed a major stumbling block to create an artificial pancreas; 3) Osteoporosis-a problem affecting an estimated 24 million Americans. Recent advances in techniques to study bone structure have furthered the development of a better understanding of the hormonal and other biochemical factors that hold promise for better therapies. Without repair, new investigators will become discouraged and leave the field as the percentage of approved grants funded each year continues to decline. Without repair, instrumentation and facility needs will go unmet, further slowing research progress. Without repair, the necessary pool of young trained investigators will not be available to lead this important endeavor into the next century. Without repair,
El
YES!
Please
we stand to lose our position as the world’s leader in biomedical sciences and technology. I recall that in President Reagan’s 1982 State of the Union Address, he stated: “The protection of our national security has required that we undertake a substantial program to enhance our military forces . . . A recogniton of what the Soviet empire is about is the starting point. Winston Churchill, in negotiating with the Soviets, observed that they respect only strength and resolve in their dealings with other nations. That’s why we’ve moved to reconstruct our national defenses?’ As a result, a substantial program of defense buildup was embarked upon by the Reagan Administration and the Congress. Military spending increased by $120 billion under the Reagan Administration; in fact, in 18 months the military spends on research and development what the NIH has spent since the turn of the century. In the past decade, United States military spending has more than doubled, from less than $130 billion in FY ‘79 to $300 billion in FY ‘89. Today we need to embark upon a disease defense buildup like that undertaken in the 1980s to respond to the preceived military threat of the Soviet’s. Repair of the faults threatening the integrity of our biomedical enterprise will require nothing less than a mobilization of resources and resolve. It will require a reordering of our nation’s budget priorities from programs which destroy life to those which preserve and enhance life. I am committed to this goal, but clearly we need to develop a broader constituency. Ultimately, the constituency I am talking about will be built only when we are able to make the clear connection between the intimately human needs of medical research and the cold confines of the budget process. When budget negotiators hammer out agreements, we deal with complicated calculations and endless reams of paper. We are isolated -- insulated -from human suffering and human needs. You must force us to deal with those human faces of suffering, and to be accountable for the trade-offs.
to
my 1993 subscription
enter
The
FASEB
_______________________
NAME________________________________________________________
PHONE
ORGANIZATION
DEPARTMENT
ADDRESS
_________________________________________________
_____________________________________________________ TEPO
STALCODECO 993U .S.R ATES(
F
OutsideU .S.M ustA ddE xpeditedP ostageB elow)M arylandR esidentsa dd5 %S alesT ax0
ASEBS ocietyM ember$
PTIONS:L
URG UARANTEEM ouR iskN othing!I fv o’.a ed jMhfied., -,C ayc mm.ia ta .,,t ,mea ndr eceivaa , ef.mdf or C o OO ItIOfl.C
390
IC heckE
N onmember$
September
1992
950
I nstitution$ 2500 S
THERC OUNTRIESa dd$ 480 26274-F AX0 35 93-2709P
nclosed(
U.S.c urrencyo
nly,d rawno
J
tudent/Fellows$
APANR ates&
nU .S.b
0
M asterCard
L
equired)L
IR etired$ 39L
3-12S hinbashi1
C home,M
ank)O
hecksp ayablet oT heF ASEBJ ournal#{149} 9 650R ockvilleP nvoiceRequiredP .O.# _ _________________________I
harget omy:
39( certificationr
O rders:U SACO,Corp.,1
akec
ike#{149} B ethesda,M
D2
0814-3998Y
IV ISAm
ard# E
xpires
ardholdersS ignatureE
XPEDITEY OURO RDER:#{149} C
Vol. 6
__________________ ZIP
UNTRY1
IM EXICO/CANADAa dd$ 200 A LLO inato-Ku,T oyko,1 05J apan;T elexJ AYMENTO
__________________
BLDG/ROOM
CITY
Journal
all1 -800-43-FASEBx7
027( metroD .C.3 01-530-7027(
NEWS & FEATURES
(JFAXF
AX1 -301-530-7001)
3031
w.fasebj.org by Iowa State University Serials Acquisitions Dept (129.186.138.35) on January 23, 2019. The FASEB Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNum
