Washington
Round-Up
February 27, 1998
Northup Addresses Ad-Hoc Group
on Medical Research Funding
Date posted on the Web: March 09,
1998
On Thursday, February 26, 1998,
Congresswoman Anne Northup (R-KY), addressed the Ad-Hoc Group
on Medical Research Funding. Northup, a Member of the House
Appropriations Subcommittee on Labor, Health and Human Services,
and Education, talked about her experiences in dealing with
funding for the National Institutes of Health (NIH). Northup
expressed her concern with the President's FY 1999 budget,
as much of the money in his budget is based on a tobacco settlement.
Northup said that this tobacco settlement does not appear to
be an issue that will be resolved anytime in the near future.
Northup continued by stating that
earmarking has become a growing political problem for Members
on the Subcommittee. Northup said that she holds the same opinion
as Congressman John Porter (R-IL), the Chairman of the Subcommittee,
that the Subcommittee should not earmark, but instead should
let the NIH distribute funding as it sees fit, not Members
of Congress.
Congresswoman Northup is a first
term Member and represents the Louisville, Kentucky area.
Hearing on Assessing Health Care
Quality
The Health Subcommittee of the House
Ways and Means Committee held a hearing on February 26, 1998,
on health care quality. The hearing was designed to take a
broad look at issues of quality and accountability in the nation's
health care system, to help identify current measures of quality
and to examine the role of the private sector, the government,
and developing information technologies in promoting health
care quality.
Congressman Bill
Thomas (R-CA), Chairman of the House Ways & Means Health Subcommittee,
said that he did not want to see Congress pass a managed care
bill "loaded down with so many regulations that [business
leaders] will cry uncle."
Thomas explained that committee
chairs have discussed bills that require managed care organizations
to provide more comprehensive information about patients' plans
and rights to appeals.
Medicare Advisory Commission
to Hold First Meeting
The National Bipartisan Commission
on the Future of Medicare, created by the Congress last year
to review and make recommendations to improve the financial
status of Medicare, will hold its first meeting on Friday,
March 6, 1998.
The Commission's Administrative
Chairman, Congressman Bill Thomas (R-CA), said the panel will
have to consider some difficult decisions including requiring
wealthier beneficiaries to pay more and raising the eligibility
age.
Senator John Breaux (D-LA), the
Chairman of the Commission, explained that Medicare would have
to provide effective medical care to the nation's disabled
and elderly in the next century.
Gekas Offers "Sense of the
House" Legislation
Congressman George Gekas (R-PA),
has introduced House Resolution 363, which expresses the Sense
of the House of Representatives that the federal investment
in biomedical research should be increased by $2 billion for
FY 1999. The resolution is similar to the one Senator Arlen
Specter's (R-PA) Senate Resolution. Congressman John Porter
(R-IL) has co-sponsored the resolution.
Gibbons Resigns From OSTP
On Friday, February 13, 1998, President
Clinton announced that Dr. Jack Gibbons, Director of the White
House Office of Science and Technology Policy, resigned. Dr.
Neal Lane, Director of the National Science Foundation, will
replace Gibbons.
New Web Site
The NIH's Office of Science and
Education has revised their home page, http://science-education.nih.gov.
This revised site
provides information about science education resources at the
NIH as well as the "Snapshots
of Science and Medicine,' which features original articles
about hot topics in medical research.
Below are three editorials by Speaker
Newt Gingrich (R-GA), Senator Barbara Mikulski (D-MD), and
from the Buffalo News on increased NIH funding.
Personal Experiences Spur Speaker
of the House To Campaign for Increased NIH and NAS Funding
By Rep. Newt Gingrich
I must admit that
I have a personal interest in the subject of health, specifically
women's health.
Not only does my mother-in-law have diabetes, but my sister
is a survivor of breast cancer, and my oldest daughter has
both lupus and rheumatoid arthritis. So you can imagine the
level of awareness one has over the fragility of the human
condition when you have these challenges and circumstances
in your own family.
My original health care interest
was the general concept of patient management. However, I became
personally involved in diabetes as a result of my mother-in-law.
When the Centers for Disease Control informed me that diabetes
is the largest single-cost factor of Medicare, claiming 27
cents of every Medicare dollar, I was truly surprised, particularly
since diabetes is a disease on which we can have a dramatic
impact through patient awareness and education. In fact, we
can achieve both an increased quality of life for patients
and reap great financial benefit for the government and society
as a whole.
I believe we are
on the edge of a revolution in our understanding of the human
body-one that
will be profoundly greater than everything we learned in the
first couple of thousand years of science. In the next 30 to
50 years, our knowledge, the detail available, and our diagnostic
and solution capacities will all explode.
Keeping up requires
increasing the money available to fund new research, new studies,
and an information
database. It will also necessitate much more investment across
the whole base of the scientific world because medical advances-such
as magnetic resonance, which came out of physics-occur in every
field of science. That is why I strongly believe we need to
fully fund scientific institutions such as the National Institutes
of Health and the National Academy of Sciences.
Congressional policies must be aimed
at moving basic scientific research forward because this research
is extremely important to the welfare of our nation. Therefore,
in the next year, I will work hand in hand with the authorizers
and appropriators to ensure that NIH, NAS, and other research
institutes receive the resources they need to keep America
in the forefront of their scientific and technological fields.
My hope is that over the next few years we will take advantage
of potential changes in science. Therefore, we should at least
double the amount of money we spend on biological and biomedical
research. In many cases, by carefully targeting research funds
and then focusing on preventive care, we can help more people
while saving the government money.
For example, within
the past several years, NIH discovered a gene that is a major
risk factor for
Alzheimer's disease. Scientists are now searching for the direct
role that genes play in Alzheimer's so they can find ways to
prevent or at least delay the onset of the disease-which currently
has no cure or effective treatment.
The total national
cost to care for Alzheimer's patients is more than $100 billion annually
and will overwhelm our health care system early in the 21st
century if scientists don't find a way to delay, prevent, or
treat the disease. Up-front research funding will save the
United States these high future costs, and though too late
for President Ronald Reagan, it is one more thing we can do
for the Gipper.
Research gives us a much broader
understanding of scientific advances as rapidly as possible,
so increased funding will eventually accomplish the explicit
goal of making the US the primary producer of health care information
in the world. This is important because it will result in the
best health care and the longest life span, provide our children
and grandchildren with higher paying jobs and greater choices
in quality of life, and give us the highest value-added export
in the world.
Thirty years from now, we will have
somewhere between 10 and 1,000 times the amount of information
we have today on the human body. Therefore, another goal should
be the transmission of knowledge to the practitioner within
no more than 12 to 18 months of its discovery.
We should move away
from today's
model, where doctors practice medicine based almost solely
on what they learned at medical school- knowledge that could
be five or six generations out of date because the entire base
of medical knowledge has changed dramatically. This explains
why many doctors grossly underestimate the importance of early
intervention with diabetes: They are operating from an acute
care response model rather than a preventive care detection
model.
It would also be
a good idea to offer through the Internet the equivalent of
the 18th- century "encyclopediaists." The
encyclopediaists were a group that gathered to collect the
entire world's knowledge into one large set of books-the origin
of the term "encyclopedia"-that would be accessible to a relatively
knowledgeable person.
At this time, NIH's National Library
of Medicine has a MEDLINE database, which could be used as
the base for an access point on the Internet that would provide
regular updates of science. After all, the technologically
sophisticated already go on the Internet to personally research
any rare or specialized disease that they or their children
get-often learning more about the disease than their doctor.
Having this clearinghouse should lessen the fact that each
day, knowledge-especially scientific knowledge-grows obsolete
because of rapid advances. Even a serious person who works
full time to stay in touch would be left behind.
Finally, the center of the system
should be the patient, with both the doctor and the patient
focusing on preventive care and education. For preventive care
to work, we need to rely on not just the doctor but the patient
as well. We should request consumer responsibility as well
as consumer rights.
We should constantly
preach, for example, about breast cancer detection-about self-exams and
doctor-supervised exams-because every woman has a life-dependent
obligation to be regularly checked. Yet this, as with men and
the prostate, doesn't routinely occur.
In other words,
this consumer model is not about expecting the world without
any effort-and then
receiving it. Because the truth is, 95 percent of the responsibility
is on the patient. In the end, it is those who don't practice
wellness or active and healthy living who cost the nation millions
in health care costs and decreased quality of life.
This requires a
revolution on two levels: changing our culture-as with welfare reform-to
put the burden back on the individual citizen, and changing
our
doctor- centered model. If patients do not take up their share
of the responsibility, doctors end up simply spending money
and resources to manage the collapse.
It is not just enough to stay alive
to avoid death. We want people to be healthy and active and
capable of leading full lives into their 90s.
This is the only goal worth focusing
on.
Presently, we are
already moving toward a prevention, early detection, and wellness
model that
has as its end goal avoiding the hospital and the emergency
room by creating an environment in which people stay healthy.
My other two suggested changes-an increase in research and
the development of a universal system of knowledge accessible
to both professionals and patients-should revolutionize health
in the US.
This combined effort should produce
a dramatically healthier and financially smarter system.
Rep. Newt Gingrich (R-Ga) is the
Speaker of the House.
NIH Needs More Money to Continue
Its Biomedical Legacy
By Sen. Barbara Mikulski
The National Institutes
of Health form the world's number-one biomedical research institution.
The work of NIH improves the health of every American, and
its impact in the past 25 years has been remarkable.
Within this period, mortality rates
related to heart disease and strokes have decreased 40 percent
and 60 percent, respectively. The number of Americans who survive
cancer for five years or longer has increased by more than
50 percent. Scientists have developed a vaccine for hepatitis
B and other illnesses. NIH has made each of these and multiple
other medical advancements possible.
As a crucial link
in the growing biotech/biomedical industry, NIH's goal is to produce new biomedical
knowledge that will "help prevent, detect, diagnose, and treat
disease and disability in humans, from the rarest genetic disorder
to the common cold."
In order to conduct this life-saving
research, the NIH requires strong support from Congress. And
we have been there for NIH each year, providing more than $10
billion for NIH for each of the last five years.
I have been proud to work with both
Democratic and Republican Senators to secure strong funding
for NIH.
But while Congress
has managed to increase NIH's funding each year, more funding is needed. I
want to see NIH's budget double so that more medical research
can be performed to prevent more illnesses, cure more diseases,
and save more lives.
According to Selma
J. Mushkin, author of "Biomedical Research: Costs and Benefits," every
dollar invested in biomedical research between 1900 and 1975
produced
a $10 to $15 return. This research has also created or enhanced
non-biomedical industries. Basic research makes up a minuscule
amount of our national spending on health care/medical industries,
estimated at less than one percent, and yet it produces returns
that are priceless.
One example of a
solid return from Congress's investment in NIH is the development
of a two-stage diagnosis-treatment of breast cancer. The development
of this
two-stage method means that patients with benign lesions only
have to endure the first stage, an outpatient biopsy.
Developing the method
was expensive-the
cost was $14.3 million each year for 15 years. But by reducing
treatment costs, the technology has meant savings of an estimated
$263 million to $526 million every year since.
The money that NIH receives goes
to fund approximately 25,000 different research grants each
year, through all 24 institutes and centers. A small percentage
of the budget funds research conducted at the various institutes
of the NIH. Most of the money, however, is allocated outside
NIH to researchers across the country. More than 50,000 scientists,
doctors, and researchers at 1,700 institutions use NIH grant
money each year. The money goes to fund the researcher, the
research equipment needed, and the administrative costs of
research.
NIH uses a long list of criteria
to determine which research projects receive funding. How much
funding a research project receives depends on the number of
deaths caused by a disease; the number of people inflicted
with the disease; the degree of disability produced by the
disease; the degree to which the disease inhibits a normal,
productive, comfortable life; the economic and societal costs
of the disease; and the degree of control over the spread of
the disease.
Even with these
criteria in place, however, sometimes certain important areas
of research are
overlooked. One of these areas is women's health, which is
why I fought alongside my former colleague, Sen. Nancy Kassebaum
(R-Kan), for the creation in 1990 of an Office of Research
on Women's Health within the NIH.
ORWH has a threefold
mandate: to enhance the research of women's health issues along with diseases
that relate specifically to women; to ensure that women are
equally represented as biomedical research subjects; and to
increase the recruitment, retention, and advancement of women
in biomedical careers. ORWH has also collaborated to help determine
the content of women's health in medical school curricula.
One of the major
research projects of ORWH is the Women's Health Initiative-a prevention study
to examine major causes of death, disability and frailty, heart
disease and stroke, cancers (especially breast cancer and colorectal
cancer), and osteoporosis in post-menopausal women of all races
and from every socioeconomic background. Many of ORWH's studies
benefit men as well as women by examining the role of gender
in the biological and physiological processes.
But ORWH is only
one of the 24 separate research institutes, centers, and offices
that make up NIH.
The Human Genome Project, for example, involves constructing
an integrated human genetic linkage map with more than 5,000
markers to aide scientists in identifying disease genes. Launched
in 1990, the project's ultimate goal is to decode, letter by
letter, the exact sequence of all three billion nucleotide
bases that make up the human genome.
This project has
already had a profound effect in the field of biomedical research.
The pace of gene
discovery has quadrupled since the project began. Accelerated
gene discovery has remarkable consequences for you and me-in
the cases of some diseases, a simple blood test can detect
high-risk individuals.
The first beneficiaries will be
families facing a high risk of colon cancer, whose members
can be tested to see if they carry the altered gene.
We need NIH for three important
reasons: Its research prevents illness, cures disease, and
saves lives. If we fail to continue our strong financial support
of NIH, we will be failing the American people by denying them
the health and disease-free living they deserve.
Sen. Barbara Mikulski (D-Md) is
the ranking member of the Labor and Human Resources subcommittee
on aging.
Buffalo News Editorial
Christopher Reeve played Superman
on the big screen until he fell from a horse three years ago.
In a tragic instant, he was paralyzed from the neck down. Since
then, Reeve has become a part-time lobbyist for the thousands
of Americans with similar injuries, appealing to Washington
for more federal research into how regenerate damaged nerve
tissue.
Given modern technology
and genetic research, that's not an impossible quest. Additional
financing could help scientists and researchers find the key.
Fortunately, Washington
seems ready to answer the appeals of Reeve and others for more
research
dollars-not just to fight nerve damage, but to combat many
diseases and disabling conditions that cost Americans not only
their health and economic productivity, but often their lives.
The tide is running strong in the White House and Congress,
among Democrats and Republicans, to raise support substantially
for biomedical research.
Millions of these
new dollars would go into cancer research, attacking one of
America's major killers.
The Roswell Park Cancer Institute could be expected to gain
some of those dollars. That would benefit cancer research generally
and also Roswell Park as a valuable institution in the Buffalo
community.
The votes haven't
been taken yet, and there are no guarantees. But signs of support
for the additional
research funds are encouraging.
Touting the explosion of advances
against disease in his State of the Union address, President
Clinton alluded to the pace of advances.
In the 1980s, he
said, it took nine years to identify the gene causing cystic
fibrosis. "Last year,
scientists located the gene that causes Parkinson's disease
in only nine days."
Within a decade,
he continued, " 'gene
chips' will offer a road map for prevention of illnesses throughout
a lifetime."
Clinton wants to back his rhetoric
with hard cash. His new budget for next year requests $1.15
billion more for the National Institutes of Health. That would
mean a total NIH budget of $14.8 billion, twice the amount
spent in 1990. Within five years, Clinton wants $20 billion
annually for the NIH.
The politics look
right. The nation's
leaders seem to realize how popular an initiative like this
will be with the voters. And both parties are also talking
about the value of research in other scientific areas to support
new jobs and commerce. Research discoveries can keep the United
States ahead of the game economically in diverse fields, from
medicine to agriculture, pharmaceuticals to biotechnology.
"We are in the golden age of discovery,
one unique in human history," Dr. Richard D. Klausner, director
of the National Cancer Institute, says, adding that "knowledge
about the fundamental nature of cancer is exploding."
That's one reason
why his institute wants $60 million to subsidize the salaries
of scientists at
the 57 cancer centers, including Roswell Park.
Another is more mundane. Despite
numerous financial advantages in health care, the growth of
health-maintenance organizations is drying up resources that
once went to pay for medical research. HMOs prefer hospitals
and treatments that charge less. Research is expensive. Hospitals
that do more of it cost more.
Dr. Bruce Holm,
associate dean for research and graduate studies at the University
at Buffalo
School of Medicine, says the growth of HMOs has "clearly" made
research money harder to find for Western New York hospitals
and institutions.
The governments pushing HMOs to
help control the spiraling costs of health care shoulder a
responsibility to pick up the slack in research.
"What we are doing today," says
Sen. Alfonse D'Amato, R-N.Y., "making scavengers and beggars
of the best in biomedical research, is just simply wrong."
In New York, with its abundance
of great medical treatment and research centers, including
Roswell Park, beggaring research is clearly indefensible.
